A Japanese health success story: trends in cardiovascular diseases, their risk factors, and the contribution of public health and personalized approaches

There has been a substantial decline in mortality from stroke and ischemic heart disease (IHD) in Japan between the 1960s and 2000s, which contributed to placing Japanese at the top of world's life expectancy rankings. That mortality decline was attributable to reductions of blood pressure and smoking, in spite of increases in dyslipidemia and diabetes mellitus. The combination of public health and personalized treatment activities to enhance sodium reduction, balanced diets, smoking prevention/cessation as well as hypertension detection and treatment have contributed to the reduction of cardiovascular diseases, demonstrated by a community-based stroke prevention program. The health success story, however, contains an underlying concern about future health threats, the plateaued IHD mortality decline and increased IHD incidence among urban middle-aged men, probably due to increased dyslipidemia and diabetes. The IHD incidence and mortality trends need to be monitored because of a potential future problem for predictive, preventive and personalized medicine.