Recent Trends in Cardiovascular Disease and Risk Factors in the Seven Countries Study: Japan

  • Yoshinori Koga
  • Ryuichi Hashimoto
  • Hisashi Adachi
  • Makoto Tsuruta
  • Hiromi Tashiro
  • Hironori Toshima

Summary

Rapid socioeconomic developments in Japan since the beginning of the Seven Countries Study in 1958 have brought remarkable changes in lifestyles and dietary patterns. Time trends in nutrient intake, risk factors, and cardiovascular disease (CVD) mortality and morbidity have been monitored in men aged 40–64 in a Japanese cohort of the Seven Countries Study, in Tanushimaru, a typical farming town on Kyushu Island.

The total daily calorie intake decreased from 2837 Kcal in 1958 to 2228 Kcal in 1968, and remained stable thereafter. The carbohydrate intake in percentage of total daily calories decreased markedly, from 78.1% in 1958 to 60.6% in 1989, in contrast to large increases during this period in protein intake (from 10.9% to 15.6%) and fat intake (from 5.3% to 21.6%).

The mean serum cholesterol level was 150 ± 41 mg/dl in 1958 (Keys method), and rapidly increased to 161 ± 32 in 1977 and to 188 ± 37 mg/dl in 1989 (enzymatic method). The frequency of overweight (body mass index exceeding 26) was 8% in 1958, and gradually increased to 11% in 1977 and to 18% in 1989. The frequency of diastolic hypertension (>95 mmHg) gradually increased from 8% in 1958 to 20% in 1982, and then declined to 13% in 1989. The frequency of isolated systolic hypertension also decreased steadily to 1989. The percentage of smokers decreased from 69% in 1958 to 55% in 1989.

The 15-year mortality and incidence rates for stroke and myocardial infarction were compared between two separate cohorts in Tanushimaru, the first sampled in 1958 and the second in 1977. Age-adjusted death rate from all causes declined from 17.6 to 7.4/1000 per year. Stroke mortality declined dramatically from 4.6 to 0.8/1000 per year, while no appreciable change occurred in the death rate from myocardial infarction (0.3 to 0.5/1000 per year) or sudden deaths (0.4 to 0.6/1000 per year). Stroke incidence declined from 6.7 to 4.4/1000 per year, but no appreciable trend was observed in the incidence of myocardial infarction (0.9 to 1.2/1000 per year).

The large changes in dietary patterns and lifestyles in Tanushimaru since 1958 have been associated with a remarkable reduction in stroke, but no increase in myocardial infarction. It is suggested that dietary changes in Tanushimaru in the last 30 years have contributed to the prevention of cardiovascular diseases. Continuation of the rapid increase in dietary fat calories could, however, change this favorable picture.

Key words

Nutrient intake Food consumption Risk factors Mortality and morbidity trends Stroke Myocardial infarction 

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References

  1. 1.
    Keys A, Aravanis C, Blackburn H, Buzina R, Djordjevic BS, Dontas AS, Fidanza F, Karvonen MJ, Kimura N, Menotti A, Mohacek A, Nedeljkovic S, Puddu V, Punsar S, Taylor HL, van Buchem FSP (1980) Seven Countries Study. A multivariate analysis of death and coronary heart disease. Harvard University Press, Cambridge, Mass.Google Scholar
  2. 2.
    Toshima H, Tashiro H, Sumie M, Koga Y, Kimura N (1984) Nutritional prevention of cardiovascular disease. In: Lovenberg W, Yamori Y (eds) Changes in risk factors and cardiovascular mortality and morbidity within Tanushimaru 1958–1982. Academic Press, New York, pp 203–210Google Scholar
  3. 3.
    Ministry of Health and Welfare of Japan (1993) Health Welfare Stat 40: 43–87Google Scholar
  4. 4.
    Keys A, Aravanis C, Blackburn H, van Buchem FSP, Buzina R, Djordjevic BS, Dontas AS, Fidanza F, Karvonen MJ, Kimura N, Lekos D, Menotti M, Puddu V, Taylor HL (1966) Epidemiological studies related to coronary heart disease: characteristics of men aged 40–59 in Seven Countries. Acta Med Scand 460 [Suppl 180]: 1–392Google Scholar
  5. 5.
    Shimamoto T, Komachi Y, Inada H, Doi M, Iso H, Saitou S, Kitamura A, Iida M, Konishi M, Nakanishi N, Terao A, Naitou Y, Kojima S (1989) Trends for coronary heart disease and stroke and their risk factors in Japan. Circulation 79: 503–515PubMedCrossRefGoogle Scholar
  6. 6.
    Ueda K, Arakawa J, Tanaka K, Omae T, Fujishima M (1990) The recent trends of atherosclerotic diseases and of their risk factors (in Japanese). J Jpn Atheroscler Soc 18: 125–131Google Scholar
  7. 7.
    Komachi Y, Iida M, Ozawa H, Shimamoto T, Konishi M, Ueshima H, Goda N, Furukawa M (1975) Interrelationship of food and stroke in Japan. Ann Rep Center Adult Dis Osaka 15: 82–93Google Scholar
  8. 8.
    Ueshima H, Tatara K, Asakura S, Okamoto M (1987) Declining trends in blood pressure level and the prevalence of hypertension, and changes in related factors in Japan, 1956–1980. J Chron Dis 40: 137–147PubMedCrossRefGoogle Scholar
  9. 9.
    Inada H, Iida M, Shimamoto T, Konishi M, Doi M, Nakanishi N, Terao A, Naitou Y, Iso H, Fukuuti K, Saitou S, Kitamura A, Kojima S, Funaki M, Komachi Y (1986) Morbidity trends in stroke and ischemic heart disease and changes in the major risk factors for stroke in rural farming area in Akita prefecture, Japan (in Japanese with English abstract). Jpn J Pub Health 22: 387–397Google Scholar
  10. 10.
    Kimura N, Toshima H, Nakayama Y, Takayama K, Tashiro H, Takagi M (1979) Fifteen-year follow-up population survey on stroke: A multivariate analysis of the risk of stroke in farmers of Tanushimaru and fishermen of Ushibuka. In: Yamori Y, Lovenberg W, Freid ED (eds) Prophylactic approach to hypertensive diseases. Raven, New York, pp 505–510Google Scholar
  11. 11.
    Blackburn H, Jacobs DR (1989) The ongoing natural experiment of cardiovascular diseases in Japan. Circulation 79: 718–720PubMedCrossRefGoogle Scholar
  12. 12.
    Konishi M, Iida M, Naitou M, Terao A, Kiyama M, Kojima S, Shimamoto T, Doi M, Komachi Y (1987) Studies on the relationship between the trends of serum total cholesterol level and the incidence of cerebro-cardiovascular diseases based on the follow-up studies in Akita and Osaka—with a special reference to the optimal serum total cholesterol level preventing cerebral hemorrhage and coronary heart disease (in Japanese with English abstract). J Jpn Atheroscler Soc 15: 1115–1123Google Scholar
  13. 13.
    Tokudomi S, Yanaguchi Y (1989) Analysis of the causes of unexpected acute death of autopsied cases. J Clin Sci 25: 671–678Google Scholar

Copyright information

© Springer-Verlag Tokyo 1994

Authors and Affiliations

  • Yoshinori Koga
  • Ryuichi Hashimoto
  • Hisashi Adachi
  • Makoto Tsuruta
  • Hiromi Tashiro
  • Hironori Toshima

There are no affiliations available

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