Serum Cholesterol and Death From Coronary Heart Disease

To the Editor.—  Stamler et al¹ refer to recommendations by expert groups "to shift [by dietary measures] the serum cholesterol distribution of the whole population downward, plus special approaches for individuals and families at higher risk." They conclude: "It is a reasonable inference that the steady and marked decline in CHD mortality in the United States since the late 1960s... is related to the improvements in nutrition and serum cholesterol distribution, as well as in other major risk factors (eg, cigarette use, blood pressure)."One feature common to these major risk factors is the pronounced inverse relationship between relative risk and age.² Thus, Stamler and colleagues show that the relative risk for men in the fifth quintile of serum cholesterol concentration compared with those in the first was 7.75 for men aged 35 to 39 years at entry, but only 2.40 for those aged 55 to 57 years