Continuous decline in mortality from coronary heart disease in Japan despite a continuous and marked rise in total cholesterol: Japanese experience after the Seven Countries Study
Open accessAbstract
BACKGROUND: The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries. METHODS: We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys. RESULTS: Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50-69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries. CONCLUSIONS: Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese.
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The absolute risk of CAD in Japan is very much lower than in Western countries.
“At present, the absolute risk of CAD (incidence and mortality rate) in Japan is very much lower than that in the Western countries96).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [96]
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- Authors
- Sekikawa, A., Miyamoto, Y., Miura, K., Nishimura, K., Willcox, B. J., Masaki, K. H., Rodriguez, B., Tracy, R. P., Okamura, T., & Kuller, L. H.
- Affiliations
- University of Pittsburgh (US)
- National Cerebral and Cardiovascular Center (JP)
- Shiga University of Medical Science (JP)
- University of Hawaiʻi at Mānoa (US)
- University of Vermont (US)
- Keio University (JP)
- Corresponding author
- Sekikawa, Akira
- ORCID
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-07-16
- Volume
- 44
- Issue
- 5
- Pages
- 1614-1624
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC6086557
- OpenAlex
- W2168321882
- Cited by
- 44
- References
- 79
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 7 · 2021: 2 · 2020: 2 · 2019: 5 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 1
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Epidemiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL068200, R01 HL68200)
- Topics
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- coronary heart disease mortality, total cholesterol, mortality trends, Seven Countries Study, Westernization, cardiovascular risk factors, birth cohort comparison, sex differences in mortality, Japan, developed countries
- MeSH terms
- Adult, Aged, Australia, Blood Pressure, Canada, Cholesterol, Coronary Disease, Diabetes Mellitus, Female, France, United Kingdom, Humans, Japan, Life Style, Male, Middle Aged, Risk Factors, Smoking, Spain, Sweden, United States, Body Mass Index, Databases, Factual, Asian People
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