title: 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.
abstract: 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.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA, akira@pitt.edu.
authors.forename: Akira
authors.initials: A
authors.lastname: Sekikawa
authors.affiliation: National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Department of Health Science, Shiga University of Medical Science, Otsu, Shiga, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miura
authors.affiliation: National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Willcox
authors.affiliation: Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii, USA.
authors.forename: Kamal H
authors.initials: KH
authors.lastname: Masaki
authors.affiliation: Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii, USA.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rodriguez
authors.affiliation: Department of Pathology, University of Vermont, Burlington, VT, USA and.
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.affiliation: Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D001315:Australia; D001794:Blood Pressure; D015992:Body Mass Index; D002170:Canada; D002784:Cholesterol / Q000097:blood*; D003327:Coronary Disease / Q000401:mortality*; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005602:France; D006801:Humans; D007564:Japan; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D013030:Spain; D013548:Sweden; D006113:United Kingdom; D014481:United States
chemical_list: D002784:Cholesterol
keywords: Coronary heart disease; Japan; Western countries; international trend; risk factors; total cholesterol