In 1984 and 1985, 25-year follow-up studies were carried out in the Italian, Finnish, and Dutch cohorts of men originally examined around 1960 in the Seven Countries Study. Risk factors for coronary heart disease were determined in 2,255 men aged 65-84 years. The average serum total cholesterol levels of the elderly men in Finland and the Netherlands were similar, at around 236 mg/dl (6.10 mmol/liter). The average serum total cholesterol levels of the elderly men in Italy were about 10 mg/dl (0.26 mmol/liter) lower. During 25 years of follow-up, the average serum total cholesterol level increased by 29 mg/dl (0.75 mmol/liter) among the Italian survivors, decreased by 23 mg/dl (0.59 mmol/liter) in the Finnish survivors, and did not change in the Dutch survivors. Age, Quetelet index, and coffee consumption were the most important correlates of total cholesterol in these elderly men. Quetelet index, alcohol consumption, age, and cigarette smoking were significantly associated with high density lipoprotein (HDL) cholesterol. The results of this study suggest that modifiable risk factors are related to total and HDL cholesterol in elderly men in different cultures.