Trends in the Incidence, Mortality, and Survival Rate of Cardiovascular Disease in a Japanese Community

Abstract

Background and Purpose-The slowdown of a steeply declining trend in cardiovascular mortality has been reported in Japan, but precise reasons for this trend are uncertain. Methods-We established 3 study cohorts of Hisayama residents aged Ն40 years without a history of stroke or myocardial infarction in 1961 (1618 subjects, first cohort), 1974 (2038 subjects, second cohort), and 1988 (2637 subjects, third cohort). We followed up with each cohort for 12 years, comparing the incidence, mortality, and survival rate of cardiovascular disease. Results-The age-adjusted incidence of cerebral infarction significantly declined by 37% for men and by 32% for women from the first to the second cohort. It continued to decline by 29% for men, but the decline decelerated for women in the third cohort. The incidence of cerebral hemorrhage steeply declined by 61% from the first to the second cohort in men only, while it was sustained for both sexes in the third cohort. Stroke mortality continuously declined as a result of these incidence changes and significant improvement of survival. In contrast, the incidence and mortality rate of coronary heart disease were unchanged except for the increasing incidence in the elderly. The prevalence of severe hypertension and current smoking significantly decreased, while that of glucose intolerance, hypercholesterolemia, and obesity greatly increased among the cohorts. Conclusions-Our data suggest that the decline in stroke incidence is slowing down and that the incidence of coronary heart disease has been increasing in the elderly in recent years. Insufficient control of hypertension and the increase in metabolic disorders may contribute to these trends.

Lifetime risk of stroke and impact of hypertension: estimates from the adult health study in Hiroshima and Nagasaki

“…2 With aging of the population, stroke has become an ever more important health burden in Japan, and thus activities aiming at stroke prevention require urgent attention. Elevated blood pressure (BP) has emerged as one of the prominent risk factors for stroke.…”

Rationale and design of the KYOTO HEART study: effects of valsartan on morbidity and mortality in uncontrolled hypertensive patients with high risk of cardiovascular events

“…3 Hypertension is the most common cause of CAD and heart failure in Japan, and cerebrovascular disease is even more prevalent in the Japanese population than in Western societies. 4 The percentage of cerebral bleeding is two or three times greater than in Caucasian people in Europe and in the United States, and cerebral infarction is mostly caused by lacunar type ischaemic stroke owing to hypertensive small vessel disease. 5 The incidence of athero-thrombotic infarction or cardio-embolic infarction is currently increasing in Japan, and the dominant pathogenetic factor for stroke is changing from small arterial disease to large arterial disease in Japanese hypertensive patients.…”

A slight increase of fasting plasma glucose after 2 years was associated with electrocardiogram changes suggestive of coronary heart disease in normal subjects

“…The prevention of IHD can be considerably improved by identifying the most important risk factors of the condition and reducing their occurrence. In the Hisayama study, 3 stroke mortality continuously declined and survival significantly improved. In contrast, the only parameter linked to an increased incidence of CHD and CHD mortality was advancing age.…”

“…1 Many Japanese have easy access to hospitals and frequently undergo medical examinations, yet the prevalence and prognostic indicators of IHD remain unclear in healthy Japanese subjects. The Framingham Heart Study 2 and the Hisayama study 3 have shown the long-term natural prognosis of IHD, but their findings provide only limited help to people in the prime of their lives who wish to know the most important parameters likely to disturb and threaten their present quality of life and portend disadvantages in the future due to IHD. We sought to identify prognostic indicators for IHD in the short term, an issue scarcely evaluated by previous studies.…”