Reducing cardiovascular mortality through lifestyle change in Japan

This editorial refers to ‘Healthy lifestyle behaviours and cardiovascular mortality among Japanese men and women: the Japan collaborative cohort study’†, by E. Eguchi et al., on page 467 Following the Second World War, Japan experienced spectacular economic growth as the country became the world's second largest economy. In parallel, rates of cardiovascular disease (CVD) in Japan increased steadily for several decades as the population became exposed to a westernized lifestyle. Despite these changes, heart disease rates in Japan, China, Korea, and Taiwan are still substantially lower than those in North America, whereas stroke rates are several fold higher.1 Moreover, Japanese migrants to the USA display a three- to six-fold rise in mortality from heart disease, but the stroke mortality rate of these migrant groups is one-fifth of that in Asia. This paradoxical pattern of CVD between Japanese who are exposed to ‘western’ lifestyles while living in Japan vs. those living in the USA is intriguing and suggests that the ‘westernizing’ influences in each setting were quite different and produced variable effects. The average blood pressure level at specific levels of body mass index (BMI) in Japan is markedly higher than in US whites in all age–sex groups.2 There are continental differences in micronutrient intake that may explain the differences in blood pressure and stroke rates between these regions. In East Asian communities compared with those in North America, the mean daily intake of potassium, calcium, phosphorus, and, to a lesser extent, magnesium, is substantially lower, while sodium intake is higher.3 On the other hand, the substantially lower death rate from ischaemic heart disease in Japan has been attributed to a higher polyunsaturated/saturated fat ratio, higher omega-3 fatty acids, higher soy proteins, and lower stress. In fact, fish consumption in Japan is still among the highest in the world and the average omega-3 intake of 1 g a day is about eight times higher than the amount the typical American consumes.4 Conversely, North Americans consume more calories, total fat, saturated and trans fatty acids, as well as refined sugar, and less total carbohydrates and starch compared with East Asians.3 Smoking rates among Japanese men, however, are more than three times those observed in North America. The rapid changes in CVD rates in migrant studies demonstrate the potent effects of changing lifestyle on CVD risk in populations.

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