Prevention of cardiovascular disease, a major non-communicable disease, in a super-aging society: Health success and unsolved issues in Japan

Abstract

As far as non-communicable disease is concerned, Japan is unique in showing a substantial decline in stroke mortality and the lowest and declining mortality from ischemic heart disease during the past half century, which contributed to the elongation of a 4-year average life expectancy, leading to top longevity in the world. However, several issues have remained in the prevention of cardiovascular disease with super-aging: i) how to manage the screening and lifestyle modification for both individuals with metabolic syndrome and those with non-overweight/ obesity plus metabolic risk factors, and ii) how to enhance the referral of very high-risk individuals screened at health checks to physicians for seeking treatment and examine whether an early clinical visit was associated with a lower risk of cardiovascular disease and total mortality. Health counseling is needed for both persons with metabolic syndrome and high-risk individuals with non-obese/overweight because the population attributable risk fraction of ischemic cardiovascular disease was similar for both high-risk individuals. Standardized counseling for very high-risk individuals accelerated clinical visits and reduced levels of risk factors. In health counseling, public health nurses were more effective in increasing clinic visits. Furthermore, the earlier clinic visit after the counseling suggested a lower risk of hospitalization for stroke, coronary heart disease, heart failure, and all-cause mortality. This article reviews these epidemiological findings for health practitioners and policymakers to perform further prevention and control for cardiovascular disease in Japan and other Asian and African countries with emerging cardiovascular burden and aging.

Keywords: Japan; cardiovascular disease; epidemiology; metabolic syndrome; prevention; referral.

Figure 1.

Age- and sex-specific multivariable hazard ratios of total cardiovascular disease according to the refined category of health intervention with non-obese/overweight subtypes for screened participants. Bar: 95% confidence interval. The number of percentages: population attributable risk. ISO: information supply only, MSI: motivation-support intervention, ISI: intensive support intervention. Data Source: modification from Reference 19.

Figure 2.

"Where am I?" Chart, a flow of disease progression. The underlined parts will be filled in by the data of each subject. Source: modified from Reference 18.

Figure 3.

Cumulative proportions of clinic visits for participants in the intervention and usual care groups. Data Source: modified from Reference 20.

Figure 4.

Cumulative proportions of clinic visits for participants according to health counselor's profession. Data Source: modified from Reference 25.