Key result
Hypertension accounts for ~60% of cardiovascular disease burden in Asia, driven primarily by stroke.
Why the study?
Asian countries have higher stroke mortality and morbidity but lower CHD rates than Western countries, even after westernization and increases in dietary fat and serum total cholesterol. Whether Japanese and other Asian populations have different risk factors for CHD and stroke than Western populations has remained a subject of discussion.
This review highlights that East Asian countries experience higher stroke mortality and lower CHD mortality than Western nations largely due to high hypertension prevalence (PAF up to 60%), high salt intake, and historically lower cholesterol, though rapid westernization is increasing fat intake, obesity, diabetes, and CHD risk.
Supports hypertension and smoking control priorities in Asia; leaves open effects of westernization on rising CHD risk.
Cardiovascular disease (CVD) prevention in Asia is an important issue for world health, because half of the world’s population lives in Asia. Asian countries and regions such as Japan, the Republic of Korea, the People’s Republic of China, Hong Kong, Taiwan, and the Kingdom of Thailand have greater mortality and morbidity from stroke than from coronary heart disease (CHD), whereas the opposite is true in Western countries.1 The reasons why this specific situation is observed in countries with rapid and early-phase westernization, such as Japan and South Korea, are very interesting. The Seven Countries Study conducted by Keys et al2 in 1957 found that Japanese populations had lower fat intake, lower serum total cholesterol, and lower CHD than populations in the United States and Scandinavia, in spite of higher smoking rates. The serum total cholesterol level in Japan has increased rapidly since World War II in accordance with an increase in dietary fat intake from 10% of total energy intake per capita per day to 25%.1,2 Despite this increase, the specific characteristic of lower CHD incidence and mortality than that in Western countries has persisted.3,4 Whether Japanese people and certain other Asian populations have different risk factors for CHD than Western populations has been a subject of discussion for quite some time. In this article, we discuss the existence of higher stroke rates and lower CHD rates in Asian countries than in Western countries and the respective risk factors for this on the basis of extensive reviews of cohort studies. We also discuss whether these risk factors differ from those of Western countries. Along with this, we examine the relationship between serum total cholesterol and total stroke and its subtypes. We also address the emerging problems and important issues for CVD prevention in Asia. An extensive …
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Ueshima et al. (2008) conducted a review in Cardiovascular disease, stroke, and coronary heart disease. Traditional cardiovascular risk factors (hypertension, smoking, serum total cholesterol, diabetes mellitus, salt and fat intake) vs. Western populations or unexposed reference groups was evaluated on Stroke and coronary heart disease (CHD) incidence and mortality. Hypertension and smoking account for up to 60% and 30% of the population attributable fraction for cardiovascular disease in Asian countries, where stroke predominates over coronary heart disease.
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