CVD Japan (1961-2009)

Secular Trends in Cardiovascular Disease and its Risk Factors in Japanese: Half Century Data from the Hisayama Study (1961-2009)

1. Jun Hata1*; 
2. Toshiharu Ninomiya1; 
3. Yoichiro Hirakawa1;
4. Masaharu Nagata1; 
5. Naoko Mukai1; 
6. Seiji Gotoh1; 
7. Masayo Fukuhara1;
8. Fumie Ikeda1; 
9. Kentaro Shikata1; 
10. Daigo Yoshida1; 
11. Koji Yonemoto2;
12. Masahiro Kamouchi1; 
13. Takanari Kitazono1; 
14. Yutaka Kiyohara1

+Author Affiliations

1. ¹Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
2. ²Kurume University, Kurume, Japan

1. ↵* Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japanjunhata@envmed.med.kyushu-u.ac.jp

Abstract

Background—Changes in lifestyle and advances in medical technology during the past half century are likely to have affected the incidence and mortality of cardiovascular disease as well as the prevalence of its risk factors in Japan.

Methods and Results—We established 5 cohorts consisting of residents aged ≥40 years in a Japanese community, in 1961 (n=1618), 1974 (n=2038), 1983 (n=2459), 1993 (n=1983), and 2002 (n=3108), and followed up each cohort for 7 years. The age-adjusted incidence of stroke decreased greatly, by 51% in men and by 43% in women, from the 1960s to the 1970s, but this decreasing trend slowed down from the 1970s to the 2000s. Among the stroke subtypes, ischemic stroke in both sexes and intracerebral hemorrhage in men showed a similar pattern. The stroke mortality decreased as a result of the decline in the incidence and a significant improvement in survival rate. While the incidence of acute myocardial infarction did not change in either sex, the disease mortality declined slightly in women. From the 1960s to the 2000s, blood pressure control among hypertensive individuals improved significantly, and the smoking rate decreased, but the prevalence of glucose intolerance, hypercholesterolemia, and obesity increased steeply.

Conclusions—Our findings suggest that in Japanese, the decreasing trends in the incidence of ischemic stroke have recently slowed down, and there has been no clear change in the incidence of acute myocardial infarction, probably because the benefits of hypertension control and smoking cessation have been negated by increasing metabolic risk factors.

Key Words:

• coronary heart disease
• incidence
• secular trend
• stroke
• mortality