Smoking and a high-cholesterol diet can lead to the narrowed arteries seen in this X-ray of a diseased heart
Middle-aged male smokers with high blood pressure and raised cholesterol levels face dying about 10 years before healthier counterparts, a study warns.
The UK study looked at more than 19,000 civil servants aged 40-69 and traced what happened to them 38 years later.
The Oxford study, in the British Medical Journal, said men with these three risk factors could expect a 10-year shorter life from 50 years of age.
The British Heart Foundation said over 40s should have a heart health check.
The study was set up in 1967-70 at the peak of the vascular disease epidemic in the UK.
Participants had their height, weight, blood pressure, lung function, cholesterol and blood glucose levels measured and completed a questionnaire about their previous medical history, smoking habits, employment grade and marital status.
Current smokers made up 42% of the men, 39% had high blood pressure and 51% had high cholesterol.
They were followed up nearly 40 years later in 2005 by which time 13,501 had died.
RISK FACTORS FACTS
26% men & 25% women in England aged 35-49 smoke
23% men & 22% women in England aged 50-59 smoke
34% men & 26% women in England aged 45-54 have high blood pressure
74% men & 78% women in England aged 45-54 have high cholesterol
The researchers from the University of Oxford focused on smoking, high blood pressure and cholesterol because they are the main cardiovascular risk factors.
But when they broadened it out to look at all risk factors including obesity, diabetes and employment grade, they found a 15-year life expectancy difference between the 5% with the highest number of risk factors and the 5% who had the lowest number of risk factors.
The proportion of deaths attributed to vascular disease in old age has declined from about 60% in 1950 to less than 40% in 2005 for both men and women.
Dr Robert Clarke, of the Clinical Trial Service Unit at the University, led the study.
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He said: "We've shown that men at age 50 who smoke, have high blood pressure and high cholesterol levels can expect to survive to 74 years of age, while those who have none of these risk factors can expect to live until 83.
"It is precisely this kind of very prolonged follow-up study that is necessary to get these results - that modest differences in heart risk factors can accurately predict significant differences in life expectancy.
"The results give people another way of looking at heart disease risk factors that can be understood more readily.
"If you stop smoking or take measures to deal with high blood pressure or body weight, it will translate into increased life expectancy. "
Professor Peter Weissberg, medical director at the BHF, said: "This important study puts a figure on the life-limiting effects of smoking, high blood pressure and high cholesterol.
"It provides a stark illustration of how these risk factors in middle-age can reduce life expectancy.
"The good news is that all of us can make changes to help us live a healthy life for longer, even after 50.
"We know that stopping smoking and reducing blood pressure and cholesterol, by lifestyle changes and/or tablets, can prevent the onset of heart disease - and these findings suggest it could make a decade of difference to our lives.
"Although the study only involved men, there is no reason why the same should not apply to women.
"So, I urge all men and women over 40 to have a health check - that all GPs can provide - which will include finding out their blood pressure and cholesterol levels, and starting to address any areas of concern."
Jane Landon, deputy chief executive of the National Heart Forum, said: "Public health strategies to discourage smoking and promote healthy eating and active lifestyles from childhood are vital to prevent the accumulation in middle age of these avoidable risk factors."
Professor Alan Maryon-Davis, president of the UK Faculty of Public Health, said: "These findings also help to explain why people who are less well off are more likely to die younger.
"Poorer people tend to smoke more, eat less healthy diets and suffer more psychosocial stress - all adding to their risk of heart disease. These are the people who need help most."