Incidence of Acute Myocardial Infarction in Takashima, Shiga, Japan

Abstract

Background The incidence and mortality from ischemic heart disease (IHD) in Japan seem to be among the lowest of all the industrialized countries, but there are few reliable registers of acute myocardial infarction (AMI). Methods and ResultsTo assess the incidence of AMI in Takashima County, Shiga, Japan, from 1988 to 1998 and compare the data with similar registers in the world, cases of AMI or sudden death presumed from myocardial ischemia were registered. The criteria of AMI were based on the WHO MONICA Projects. The medical records of all the hospitals inside as well as outside the county, the original death records in the health center, and the ambulance records in the county were investigated and 291 cases were registered (190 males, 101 females; average age (mean ± SD), 69.5±12.2). The 28-day and 24-h case fatality was 38.1% and 33.0%, respectively. Age-adjusted annual incidence of AMI per 100,000 population aged between 25 and 74 years were 58.2 for men and 18.0 for women. The incidence of AMI showed a constant trend from 1988 to 1998. Conclusion The results confirmed that Japan has the lowest incidence of AMI among the industrialized countries. (Circ J 2005; 69: 404 -408)

Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke

“…China and Mediterranean countries were also lower than other countries but higher than Japanese populations. This incidence pattern is also similar to that of CHD mortality in the world [1][2][3][4][5][15][16][17][18][19][20] ; therefore, the lower CHD mortality in Japan stems from the lower CHD incidence compared to other industrialized countries.…”

“…A slight increase in 1995 for acute myocardial infarction was also due to the diagnostic change. 1955 1960 1965 1970 1975 1980 1985 1990 1995 true that the decline in CHD mortality since 1970 brought about the decline in the incidence of acute myocardial infarction [9][10][11][12][13][14][15][16] . The Hisayama Study compares the incidence of CHD as well as AMI, asymptomatic myocardial infarction and sudden death among three cohorts; the oldest is a survey taken during 1961-73, the second one during [1974][1975][1976][1977][1978][1979][1980][1981][1982][1983][1984][1985][1986], and the latest during 1988-2000 10) .…”

“…Six Japanese cohorts are available for comparing the incidence of AMI with that of the MONICA Project (multinational monitoring of trends and determinants in cardiovascular disease) conducted by WHO [15][16][17][18] . The MONICA Project started monitoring trends in AMI and stroke incidence, and their risk factors in 1985 19,20) .…”

“…The MONICA Project started monitoring trends in AMI and stroke incidence, and their risk factors in 1985 19,20) . Shortly afterwards, six Japanese cohort studies were conducted using the same registration criteria for stroke and AMI, making it possible to compare data with that of the MONICA Project [15][16][17][18][19][20] ( Fig. 3, 4).…”

Executive Summary of Japan Atherosclerosis Society (JAS) Guideline for Diagnosis and Prevention of Atherosclerotic Cardiovascular Diseases for Japanese

“…Second, when the LDL-C level falls in this range, intensive management of lipid may be required in the presence of other risk factors. Third, a trend toward an increase in CAD has been suggested in Japan 15) . Until recently, the incidence of atherosclerotic disease, typically CAD, has been relatively low in Japanese.…”