Abstract
The Bowling Green Study of the Primary and Secondary Prevention of Atherosclerotic Disease has accumulated an age–sex register of 668 consecutive patients who developed some form of atherosclerotic disease between 4 November 1974 and 1 January 1997. Observational data relating to levels of lipids and glucose, blood pressure, body-mass index, and cigarette-smoking status are included in the age–sex register. Analysis of this database clearly shows that cigarette smoking is the main cause of atherosclerotic disease, including events in each of the vascular trees, as well as multiple-system disease and death, at ages much earlier than the ages at which similar atherosclerotic events occur in ex-smokers. Ex-smokers, in turn, suffer corresponding events at earlier ages than do never-smokers. Cigarette smoking produces atherosclerotic events at roughly the same age irrespective of status of other risk factors and is therefore the single most important risk factor for atherosclerosis.
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