Country case for chronic disease: Japan and its staggeringly low cardiovascular death rates

(Yoshikazu Tsuno/AFP/Getty Images)

“Noncommunicable diseases (NCDs), primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, are responsible for 63% of all deaths worldwide (36 million out of 57 million global deaths)” – World Health Organization, 2011

Noncommunicable diseases – also referred to as chronic diseases – remain the number one global cause of deaths worldwide and cardiovascular disease (CVD) or heart disease remains at the top of the pedestal. Chronic diseases significantly concern the elderly, as 75% of 36 million global deaths attributable to chronic disease occurred beyond age 60 in 2011. In this report, we must highlight Japan – the country with the highest average elderly age yet the lowest cases of heart disease.

As early as 1981, Professor Geoffrey Rose of Epidemiology wrote an article in the British Medical Journal about taking the action of preventing CVD. He showed staggeringly low numbers of how Japan in 1968 had just over 100 deaths per 100,000 population attributable to coronary heart disease (CHD), whereas before the United States was able to drop their rates considerably over time, in 1968 they had the highest number – with over 800 deaths per 100,000 population. Sweden was around the middle, with approximately 450 deaths per 100,000 population. Further, Rose adds, “The Japanese owe their low rates not to their genes but to their way of life: when they move to America they rather quickly acquire American rates.” In addition to affirming Japan’s low death ratio, the United States and Australia had shown drops of 25% till year 1977, indicating that therapeutic advancements and prevention strategies can considerably reduce the deaths from CHD – which represent approximately half of CVD deaths (Iso, 2008). Japan has been able to keep their low CHD death ratio similar with a slight drop till 1977 (Rose, 1981) and has considerably dropped further – with over a 50% drop from this time frame to year 2000, having now around 37 deaths per 100,000 population (Iso, 2008). Dr. Hiroyasu Iso of Social and Environmental Medicine wrote in the Journal of the American Heart Association that Japan still has the lowest CHD ratio of high-income countries – between one-third and one-fifth that of the United States.

The decline of CHD deaths in Japan is attributable to the decline of mean systolic blood pressure levels and the prevalence of smoking. However, an issue is arising with a high prevalence of western fast-food diets increasing the mean serum total cholesterol and triglyceride levels (Iso, 2008). It is curious as to how Japan started with such a low ratio of deaths from CHD, and as we have heard from Professor Rose, it is due to their lifestyle. Is this lifestyle perhaps significantly affected by the practice of Complementary and Alternative Medicine (CAM) or Traditional Medicine (TM) involving the use of exercise, herbs, or other techniques? In order to explain a counterbalance for a high-fat-intake diet, I recommend collaboration with a national research organization such as the Japan Society of Oriental Medicine to investigate how the effects of Japanese Traditional Medicine, i.e. Kampo, derived from Chinese Traditional Medicine might be attributable to the low incidence of CHD deaths in Japan.

According to Dr. Johan von Schreeb of Karolinska Institute’s Public Health Sciences, approximately 1/3rd of Japan’s population is over age 60 and the country has the highest average aged population in the world – leading with 84 as the mean age of life expectancy. Prevention of chronic diseases is on the forefront of today’s world, with so many medical advances leading not only high-income countries but countries all over the world to jolt up in life expectancy. And as life expectancy rises, so does the demand for prevention of chronic disease. Is there a golden formula somewhere out in the Far East that could face this issue? As the country with the leading population of elders, perhaps there really is something about Japan that the world could need.


The Epoch Times. Image Retrieved April 4th, 2012:

World Health Organization. 10 FACTS ON NONCOMMUNICABLE DISEASES. September 2011. Retrieved March 29th, 2012:

Schreeb, Johan von. Lecture on Disasters & Relief. January, 2012. Karolinska Institutet, Solna, Stockholm. IHCAR Department of Public Health Sciences.

Hiroyasu, Iso. 2008. Changesin Coronary Heart Disease Risk Among Japanese. Journal of the American Heart Association 118:2725-2729.

Rose, Geoffrey. 1981. Strategy of prevention: lessons from cardiovascular disease. British Medical Journal 282:1847-1851.


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About Adrian Levitsky

Adrian is a Research Technician and Doctoral Student at Karolinska Institutet's ClinTRID department for Inflammatory (Autoimmune) Disease research. He is a blogger for the Silverevolution initiative by ACCESS Health International. He defended his Masters thesis in Global Health at Karolinska and worked together with the CAMbrella project's Swedish team ( in analyzing global key stakeholders of Complementary and Alternative Medicine (CAM) and Traditional Medicine (TM). He has an avid interest in research. Particularly, he wishes to research CAM/TM and promulgate an evidence base for the potential effectiveness of integrative care -- as this communication still is lacking globally. Adrian has a background starting as a pilot at Embry-Riddle Aeronautical University, which later evolved to studying Human Factors Psychology with a drive to understand how man and machine work together. This field often focuses heavily on research and involves testing available theories or finding new solutions to prevent work-related injuries, reduce stress, and emphasize usability/ergonomics. Teaching English in South Korea made him realize the need for innovation and imagination for all school curricula in order to solve today’s dilemmas.

One response to “Country case for chronic disease: Japan and its staggeringly low cardiovascular death rates”

  1. Torkel Falkenberg says :

    Thank you for an interesting article with the challenging hypothesis that Japanese traditional medicine might be a contributing factor to increased survival. Indeed research from Holland by Baars et al indicate that physicians with competence in complementary medicine have patients that live longer and cost less for the health care system compared to patients attending to physicians with no training in complementary medicine.

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