Changes in Coronary Heart Disease Risk Among Japanese

Heart disease is the second most prominent cause of mortality in Japan, and coronary heart disease (CHD) accounts for approximately half of heart disease–related deaths.1 The CHD mortality rate in Japan has been one-third to one-fifth that in the United States,1–5 even when validated fatal CHD and sudden cardiac deaths were compared.3–5 However, there is growing concern about a possible increase in the incidence of and mortality from CHD because of the westernization of lifestyles such as high-fat diets and sedentary work patterns associated with socioeconomic development since the 1960s.6–11 The present report reviews original articles on population-based surveys of the mortality, incidence, and risk factors of CHD. It focuses on their trends since the 1960s because Japan has experienced rapid changes in lifestyles and environment accompanying socioeconomic development and maturation. To identify the relevant literature, PubMed was searched for articles published from 1963 through June 2007. The following search key words were used: coronary heart disease or coronary artery disease or ischemic heart disease or myocardial infarction ; mortality or incidence or risk factor ; Japan or Japanese ; and epidemiology . Bibliographies of key articles were reviewed and experts in the field were consulted to identify all of the major population-based studies. ### Trends in Mortality From CHD Age-adjusted mortality rates from CHD declined 50% for men and 65% for women between 1969 and 19928,9 and has continued to decline.1,2 According to the World Health Organization database, the age-adjusted annual CHD mortality rate in 2000 was 37 per 100 000 for men and 18 per 100 000 for women, which was the lowest among developed countries.2 There are, however, sex, age, and regional variations in CHD mortality trends.9 The age-adjusted CHD mortality rates declined from 57 per 100 000 in 1969 to 1970 to 27 per …