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  • Original Article
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Differences in cardiovascular disease risk factors between Japanese in Japan and Japanese-Americans in Hawaii: the INTERLIPID study


Despite increase in serum total cholesterol, high smoking rate, and frequency of adverse blood pressure levels in Japan, coronary heart disease (CHD) incidence and mortality apparently remain substantially lower at all ages in Japan than in the US and other Western societies. To better understand these differences, we compared CHD biomedical risk factors and dietary variables in Japanese living in Japan and 3rd and 4th generation Japanese emigrants living a primarily Western lifestyle in Hawaii, in an ancillary study of the INTERMAP. Men and women aged 40–59 years were examined by common standardized methods—four samples in Japan (574 men, 571 women) and a Japanese-American sample in Hawaii (136 men, 131 women). Average systolic (SBP) and diastolic (DBP) blood pressures were significantly higher in men in Japan than in Hawaii; there were no significant differences in women. The treatment rate of hypertension was much lower in Japan than Hawaii. Smoking prevalence was higher, markedly so for men, in Japan than Hawaii. Body mass index, serum total and low-density lipoprotein cholesterol, HbA1c, and fibrinogen were significantly lower in Japan than in Hawaii; high-density lipoprotein cholesterol was higher in Japan. Total fat, saturated fatty acid intake, and Keys dietary lipid score were lower in Japan than in Hawaii. Polyunsaturated/saturated fatty acid ratio and omega-3 fatty acid intake were higher in Japan than in Hawaii. In conclusion, levels of several, especially lipid, CHD risk factors were generally lower in Japanese in Japan than in Japanese in Hawaii. These differences were smaller for women than men between Japan and Hawaii. They may partly explain lower CHD incidence and mortality in Japan than Western industrialized countries.

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This study was partly supported by the Ministry of Education, Science, Sports and Culture, Grant-in-Aid for Scientific Research (A), No. 090357003 in Japan and the Suntory Company; the Pacific Research Institute is supported by the Robert Perry Fund and the Hawaii Community Foundation. The INTERMAP Hawaii Center was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health (Grant 5-RO1-HL54868-03). The INTERMAP Study is supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MA, USA (Grant 2-RO1-HL50490-06), as well as national and local agencies in the four countries. We express sincere thanks to Dr J Stamler for his useful comments on this paper.

INTERLIPID Study leadership:

Chairperson of INTERMAP in Japan: Hirotsugu Ueshima. Principal and co-principal investigators: S Saitoh, S Tanaka, K Shimamoto (Sapporo, Japan), H Nakagawa, K Miura, K Yoshita (Kanazawa), A Okayama, SR Choudhury, Y Kita (Shiga, Japan); T Hashimoto, K Sakata, S Morioka (Wakayama, Japan). Principal and co-principal investigators in Hawaii: JD Curb, B Rodriguez, K Masaki. National nutritionist, Japan: N Okuda. National conutritionist, Japan: K Yoshita. Research associates in Japan: T Isomatsu, T Takahashi, (Sapporo); Y Naruse, M Higashiyama (Kanazawa); T Kadowaki, M Watanabe, K Yamamoto, H Fuse, M Yoshioka, A Morino, Y Sekiya (Shiga); O Mohara, F Kinoshita, M Ohta, Y Shibe, K Oki (Wakayama). Local nutritionists: K Ishishita (Sapporo); K Yoshita (Kanazawa); A Morino, Y Sekiya (Shiga); Y Shibe, K Oki (Wakayama); J Lee (Honolulu). Management committee in Japan: H Ueshima, A Okayama, SR Choudhury, N Okuda, Y Kita. INTERMAP International Steering and Editorial Committee: J Stamler and P Elliott (Co-Chairs), B Dennis, AR Dyer, H Kesteloot, K Liu, R Stamler (deceased), H Ueshima, B Zhou.

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Ueshima, H., Okayama, A., Saitoh, S. et al. Differences in cardiovascular disease risk factors between Japanese in Japan and Japanese-Americans in Hawaii: the INTERLIPID study. J Hum Hypertens 17, 631–639 (2003).

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