Experts have known for years that both smoking and high blood levels of cholesterol are strong contributors to cardiovascular disease. In the US, smoking and high-fat, high-cholesterol diets often go hand in hand, raising heart risks in a synergistic way.

While few studies have examined the link between smoking and heart disease in people with more favorable cholesterol levels, some have suggested that low blood cholesterol levels might help to counter the negative effects of smoking on the cardiovascular system.

However, many of the studies tended to be small and didn't follow patients for many years, according to the authors of the new study, led by Dr. Lucila Blanco-Cedres of Northwestern University in Chicago, Illinois.

Blanco-Cedres and her team examined medical records that contained the cholesterol levels, smoking patterns and health histories of more than 8,800 middle-aged men. The men's health was followed-up over 25 years.

About 41% of the men were current smokers, and 37% had a total cholesterol level less than 200 milligrams per deciliter, a level considered desirable under current guidelines.

Among smokers, the risk of developing coronary heart disease or any cardiovascular disease was of the same magnitude for all cholesterol levels, according to the report in the current issue of the American Journal of Epidemiology.

In addition, the investigators found that risk of death in men who had never smoked was substantially lower compared with smokers with low cholesterol.

The researchers did find good news for men who quit smoking, no matter what their cholesterol levels were. Their risk of dying from cardiovascular disease--and indeed all causes of death--was attenuated to almost the same level as that of men who never smoked.

Worldwide, about 3 million deaths a year are attributed to smoking, and it is estimated that this number will rise to more than 10 million by the year 2025, the study authors note.

SOURCE: American Journal of Epidemiology 2002;155:354-360.

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