The Medical Research Council (MRC) Social and Public Health Sciences Unit and the University of Glasgow have published a study today in the British Medical Journal of how realistic male stereotypes are in relation to their risk of coronary heart disease based on a survey of over 6000 Scottish men.

The researchers were interested in two stereotypes: 'Uncle Norman', a familiar male figure who ignores medical advice and lives to tell the tale, and 'the Last Person' (you'd expect), who dies from a heart attack, despite taking medical advice and living an exemplary lifestyle.

They identified a 'high risk' group of overweight heavy smokers (three per cent of all men in the study, totalling 193 people) of which 'Uncle Norman' is a subset, with 107 people. The figures show that 45 per cent of these men died before the age of 70.

The mortality rate within the 'low risk' group (of which 'the Last Person' is a subset) of lifelong never smokers who were the correct weight (six per cent of all men, totalling 337 people) was very low. Only 12 people (four per cent) died of heart disease before the age of 70.

An important finding was that only one in 25 of the men in 'the Last Person' category died from a heart attack, compared with one in four 'Uncle Normans'. Over 80 per cent of the deaths from heart disease in 'the Last Person' group were associated with other less obvious risks for heart disease, such as poor lung function, diabetes, previous heart disease and poorer social circumstances. Similarly, three quarters of the surviving 'Uncle Normans' had protective factors such as being taller and having lower cholesterol levels, which may help to explain their unexpected survival.

The researchers' based their paper on a study of over 6000 men from Renfrew and Paisley aged between 45-64 in the 1970s and who have been monitored for over 25 years. They were assessed on their risk of coronary heart disease on the basis of body mass index and whether or not they smoked.

Dr Kate Hunt, Senior Research Fellow at the MRC Social and Public Health Sciences Unit at Glasgow University, commented: "This explains the very large difference in coronary deaths between the groups. 'The last person' is indeed a rare occurrence but looms large in public consciousness because such deaths are dramatic, unexpected and premature. In addition to the trauma to immediate families and friends, such deaths often make a large impact locally and nationally through media coverage".

Dr Carol Emslie of the MRC Social and Public Health Sciences Unit, commented "Uncle Norman is not as common as people think, but it is true that there is a very small group of men who appear relatively immune to coronary disease risks. It is important for health promotion to acknowledge the existence of Uncle Norman while emphasising that general healthy living advice is relevant to the vast majority of us."

Professor Graham Watt, from the Department of General Practice at the University of Glasgow, said: "These interesting results put lay stereotypes in perspective. 'The Last Person' and 'Uncle Norman' are both real people, but they are both rare. The most important finding from the study is the huge difference in coronary mortality between men at high and low risk. In betting parlance, 'Uncle Norman' and 'the Last Person are both outsiders; one should not bet against the established coronary risk factors as predictors of deaths from heart disease."

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The original research was funded by the King Edward VII Memorial Trust for Renfrewshire. All subsequent research has been funded by the Medical Research Council and Glasgow University.

Heart disease accounts for a quarter of all deaths in Britain and is a priority in public health policy. The risk factors of coronary heart disease are smoking, raised blood pressure, high cholesterol, obesity and lack of exercise.

First published: 21 December 2001