Trends in sudden cardiac death and its risk factors in Japan from 1981 to 2005: the Circulatory Risk in Communities Study (CIRCS)

Abstract

ObjectiveThere is little evidence whether sudden cardiac death (SCD) is increasing in Asia, although the incidence of coronary heart disease among urban middle-aged Japanese men has increased recently. We examined trends in the incidence of SCD and its risk factors in the Circulatory Risk in Communities Study.Design and settingThis was a population-based longitudinal study. Surveillance of men and women for SCD incidence and risk factors was conducted from 1981 to 2005.SubjectsThe surveyed population was all men and women aged 30–84 years who lived in three rural communities and one urban community in Japan.Main outcome measuresTrends in SCD incidence and its risk factors.ResultsAge-adjusted and sex-adjusted incidence of SCD decreased from 1981–1985 to 1991–1995, and plateaued thereafter. The annual incidence per 100 000 person-years was 76.0 in 1981–1985, 57.9 in 1986–1990, 39.3 in 1991–1995, 31.6 in 1996–2000 and 36.8 in 2001–2005. The prevalence of hypertension decreased from 1981–1985 to 1991–1995, and plateaued thereafter for men and women. The age-adjusted prevalence of current smoking for men decreased while that of diabetes mellitus increased for both sexes from 1981–1985 to 2001–2005.ConclusionsThe incidence of SCD decreased from 1981 to 1995 but was unchanged from 1996 to 2005. Continuous surveillance is necessary to clarify future trends in SCD in Japan because of an increasing incidence of diabetes mellitus.

The Spectrum of Epidemiology Underlying Sudden Cardiac Death

“…It also appears that the incidence of SCD may be lower among Asian populations in the United States based upon death certificate data 10 . Estimates of SCD incidence in longitudinal population based studies of SCD in China 22 and Japan 53 are consistently lower than those from studies performed in North America or other regions with predominantly white populations. These racial differences in SCD/SCA incidence and survival are poorly understood, and further studies performed in large-scale population-based cohort studies of diverse ethnicity are needed to determine the origin of these disparities.…”

“…The percentage of SCDs with underlying CHD also appears to be lower in blacks versus whites (47% versus 63%) and left ventricular hypertrophy is more common among older black than white SCD victims 56 . In Japan, CHD is thought to account for a much lower percentage of SCDs 53 , although the percentage due to CHD appears to be increasing over time 57 .…”

Risk factors for sudden cardiac death among Japanese

“…In our study, hypertension was found to be the largest contributor to SCD risk as demonstrated by PAF. The age and sex-adjusted incidence of SCD in CIRCS populations decreased from 1981-1985 to 1991-1995, and reached a plateau after 1996, which corresponded primarily to the trend for the prevalence of hypertension [22]. Since the prevalence of hypertension in Japan remains higher than in Western counties [23], there is a need to continue intensive prevention programs for hypertension to prevent future SCDs as well as other cardiovascular events.…”

Significant association of RNF213 p.R4810K, a moyamoya susceptibility variant, with coronary artery disease

“…[1] Although the mortality rate of CAD in Japan is one-third to one-fifth of that in the United States,[2–5] cardiovascular disease has become the second-leading cause of death. [6] This trend is also seen in other Asian countries.…”