Within the Seven Countries Study two Japanese cohorts of men aged 40-59 were enrolled, one from the farming village of Tanushimaru (n = 508) and the other from the fishing village of Ushibuka (n = 502), both located in Kyushu. Cardiovascular risk factors were measured at entry and 10 years later in the survivors. The 25-year death rate for all causes was 30% higher in Ushibuka than in Tanushimaru (p< 0.001) and higher also from specific causes except for violence. Baseline differences in the levels of age, blood pressure, serum cholesterol, smoking habits, body mass index and heart rate explained only 19% of the difference in all-cause mortality between the two towns. Multivariate models from data of die pooled cohorts showed that age was a significant predictor of coronary heart disease, stroke, cancer, all other causes and all-cause mortality. Cigarette smoking predicted coronary heart disease, cancer and all-cause mortality. Systolic blood pressure predicted coronary heart disease, stroke and all-cause mortality. Serum cholesterol, body mass index and heart rate predicted none of these five causes of death. Changes in systolic blood pressure during the first 10 years of follow-up were direcdy related to deatiis between 10 and 25 years of follow-up, signifi-candy improving the predictive power of die multivariate model. Changes in die otiier risk factors did not contribute, however, to improved prediction. (Jpn Heart J 36: 179-189, 1995).