Longitudinal Changes in Arterial Stiffness Associated with Physical Activity Intensity: The Toon Health Study.

AIMS: Several studies have revealed an association between moderate-to-vigorous physical activity (MVPA) and arterial stiffness, which is a known risk factor for cardiovascular disease. However, a few studies have considered the difference in the longitudinal effect of its intensity in a large general population. Therefore, we examined the effect of MVPA intensity on longitudinal changes in arterial stiffness. METHODS: We conducted a prospective cohort study involving 1,982 Japanese men and women. Arterial stiffness was measured using the cardio-ankle vascular index (CAVI) at baseline and 5-year follow-up. Physical activity was quantified using the Japan Arteriosclerosis Longitudinal Study Physical Activity Questionnaire and categorized into quartiles as MVPA levels. Linear mixed models were used to examine the differences at baseline and the rate of changes in CAVI associated with MVPA levels for over 5 years. RESULTS: The multivariable-adjusted mean differences in CAVI at baseline were significantly lower in the third (ß=-0.019 [95% confidence interval {CI}=-0.033 to -0.005]) and fourth (ß=-0.018 [95% CI=-0.035 to -0.001]) quartiles of the MVPA group compared with those in the lowest quartile of MVPA, and the significant effect persisted 5 years later. CONCLUSIONS: In summary, this study provides evidence to support the existence of a threshold for beneficial levels of MVPA in the prevention of arterial stiffness. Furthermore, this study suggests that exceeding this threshold may exert similar effects on arterial stiffness. These findings suggest that an optimal level of MVPA exists for preventing arterial stiffness, and exceeding this threshold may not engender additional benefits.

Use of doubly labeled water to validate a physical activity questionnaire developed for the Japanese population.

BACKGROUND: No study has attempted to use the doubly labeled water (DLW) method to validate a physical activity questionnaire administered to a Japanese population. The development and refinement of such questionnaires require that physical activity components related to physical activity level be examined. METHODS: Among 226 Japanese men and women 20 to 83 years of age, total energy expenditure (TEE) was assessed using the Japan Arteriosclerosis Longitudinal Study Physical Activity Questionnaire (JALSPAQ), and the results were compared with TEE measured by the DLW method as a gold standard. Resting metabolic rate (RMR) was measured using the Douglas Bag method. RESULTS: The median TEE by DLW and physical activity level (PAL: TEE/RMR) were 11.21 MJ/day and 1.88, respectively, for men, and 8.42 MJ/day and 1.83 for women. JALSPAQ slightly underestimated TEE: the differences in mean and standard error were -1.15 ± 1.92 MJ/day. JALSPAQ and DLW TEE values were moderately correlated (Spearman correlation = 0.742, P < 0.001; intraclass correlation coefficient = 0.648, P < 0.001), and the 95% limit of agreement was -4.99 to 2.69 MJ. Underestimation of TEE by JALSPAQ was greater in active subjects than in less active subjects. Moderate and vigorous physical activity and physical activity during work (ie, occupational tasks and housework) were strongly related to physical activity level. However, the physical activity components that differentiated sedentary from moderately active subjects were not clear. CONCLUSIONS: Physical activity level values on JALSPAQ and DLW were weakly correlated. In addition, estimation of TEE in active subjects should be improved, and the use of a questionnaire to differentiate activity in sedentary and moderately active subjects must be reassessed.

A Cross-Sectional Study of the Relationship of Timed Up & Go Test with Physical Characteristics and Physical Activity in Healthy Japanese: The Toon Health Study.

This study evaluated the Timed Up & Go test (TUG) among healthy Japanese individuals without walking problems to clarify the relationship of TUG performance with physical characteristics and physical activity according to sex and age groups. In total, 797 men and women (30-84 years old) in Toon City, Ehime Prefecture, were assessed from 2016 to 2017. The survey data for physical characteristics, TUG performance, and physical activity measures were used. After adjusting for age according to TUG time and categorization into sex and age groups (30-64 and 65-84 years), the relationship of TUG performance with physical characteristics and physical activities was confirmed using multiple regression analysis. In men, TUG performance was associated with work and household chores in the 30-64-year age group, whereas it was only associated with skeletal muscle mass among those older than 65 years. In women, TUG performance was associated with height and amount of exercise, regardless of age. In conclusion, TUG performance may be maintained by increasing the amount of physical activity for men through work and housework, and increasing the amount of exercise for women, which may prevent the need for long-term care in the future.

The Relationship between Locomotive Syndrome Risk, Gait Pattern, and Standing Posture in Young Japanese Women: A Cross-Sectional Study.

Young people are also at risk of developing locomotive syndrome for unclear reasons. Therefore, we sought to evaluate the locomotive syndrome risk in young Japanese women and the relationship between standing posture and gait patterns. We used survey materials for physical measurements, locomotive syndrome risk tests, normal and maximum walking test, a standing posture test, and physical activity measures. A questionnaire-based cross-sectional survey was conducted with 100 Japanese female university students. The participants were divided into two groups (high-risk and low-risk groups) based on locomotive syndrome risk tests. The high-risk group accounted for 65.0% of the total participants. The high-risk group had a significantly slower walking speed and lower walking stride length than the low-risk group during maximum walking. Additionally, this high-risk group had a more prone posture than the low-risk group. Furthermore, the low-risk group included more individuals who belonged to middle and high school athletic clubs than the high-risk group. The locomotive syndrome risk was related to the walking pattern, standing posture, and past exercise habits. Therefore, long stride length, correct standing posture, and exercise habits acquired from a young age are important measures for preventing locomotive syndrome in young adults.

Influence of Insulin Resistance on the Association Between Physical Activity and Heart Rate Variability: The Toon Health Study.

BACKGROUND: Autonomic activity is possibly influenced by physical activity (PA). However, it remains unclear whether this association is modified by insulin resistance. METHODS: This population-based study between 2009 and 2012 included 2016 men and women aged 30-79 years. The PA was assessed using a validated questionnaire based on sleep, occupation, transportation, household characteristics, and leisure-time PA. Heart rate (HR) and heart rate variability (HRV) in the sitting position were determined from 5-minute recordings of pulse waves detected by a fingertip sensor. The HRV was calculated as frequency (standard deviation of normal-to-normal [NN] intervals [SDNN]), root mean square of successive differences (RMSSD), and percentage differences between normal NN intervals >50 milliseconds [pNN50]) and time domains. Insulin resistance was evaluated using the homeostasis model assessment index (HOMA-IR). RESULTS: HR, RMSSD, and pNN50 were related to the total and moderate/vigorous PA tertiles in models that included HOMA-IR. The partial regression coefficient of total PA per 1-SD increase was .05 (P = .019) for log-transformed RMSSD and 1.86 (P = .001) for pNN50. No interactive associations were observed between PA and HOMA-IR. CONCLUSIONS: Low total PA was associated with increased HR and low levels of RMSSD and pNN50, reflecting parasympathetic modulation that was not modified by insulin resistance.

Light-intensity activities are important for estimating physical activity energy expenditure using uniaxial and triaxial accelerometers.

This study evaluated the validity of the total energy expenditure (TEE) estimated using uniaxial (ACCuni) and triaxial (ACCtri) accelerometers in the elderly. Thirty-two healthy elderly (64-87 years) participated in this study. TEE was measured using the doubly labeled water (DLW) method (TEE(DLW)). TEE(ACCuni) (6.79 +/- 1.08 MJ day(-1)) was significantly lower than TEE(DLW) (7.85 +/- 1.54 MJ day(-1)) and showed wider limits of agreement (-3.15 to 1.12 MJ day(-1)) with a smaller correlation coefficient (r = 0.703). TEE(ACCtri) (7.88 +/- 1.27 MJ day(-1)) did not differ from TEE(DLW) and showed narrower limits of agreement (-1.64 to 1.72 MJ day(-1)) with a larger correlation coefficient (r = 0.835, P < 0.001). The estimated intensities of light activities were significantly lower with ACCuni. Greater mediolateral acceleration was observed during 6-min walk tests. The results suggest that ACCtri is a better choice than ACCuni for assessing TEE in the elderly.

Mortality of Japanese Olympic athletes: 1952-2017 cohort study.

AIM: To evaluate mortality among Japanese Olympic athletes compared with the general population and also evaluate their mortality based on total number of Olympics participation and intensity of sports disciplines. METHODS: Information on biography, vital status, date of birth, date of death and latest follow-up date on Japanese Olympians was retrieved from six online databases and compared. Standardised mortality ratio (SMR) was estimated according to observation periods and years from last participation in the Olympics. To further evaluate the association between mortality and total number of Olympics participation/intensity of sports disciplines within the study population, rate ratios (RRs) adjusted by sex, observation period and attained age group were estimated by a Poisson regression model. RESULTS: A total of 3381 Olympians were included in the analysis. The total person years was 94 076.82. The deaths of 153 (4.53%) Olympians were confirmed, and the overall SMR was 0.29 (95% CI, 0.25 to 0.34). SMRs categorised by years from last participation did not differ significantly. Higher mortality was observed among those who participated in the Olympics twice (RR: 1.52; 95% CI, 1.04 to 2.23) and three times or more (RR: 1.87; 95% CI, 1.08 to 3.25) compared with those who participated just once. Compared with combination of low static and low dynamic intensity category, higher mortality was observed in most combinations of middle-intensity or high-intensity categories. CONCLUSION: Japanese Olympians lived longer than the general population. More frequent participation in the Olympics and higher intensity of sports disciplines were associated with higher mortality.

[Epidemiological study of preferable life style for psychological health promotion].

OBJECTIVE: We sought to examine relationships of lifestyle factors, including diet, physical activity, sleep, alcohol consumption and smoking, with perceived stress and depressive symptoms. METHODS: Between 2001 and 2002, 7,947 men and women (mean 52.4 years) took part in examinations at the Osaka Medical Center for Health Science and Promotion. Lifestyle factors were determined by structured interview or by self-administered questionnaire. Associations of life style factors with perceived stress and depressive symptoms were tested by stepwise logistic regression analyses. RESULTS: Higher proportions of persons with depressive symptoms tended to be associated with higher proportions of persons with perceived stress. Among both men and women, low physical activity, lack of regular physical exercise, short sleeping time, to skip breakfast frequently, and having dinner within a couple of hours before going to bed were associated with both perceived stress and depressive symptoms. Men reporting between-meal or midnight snacks and having eating until they were full had higher odds ratios for perceived stress, while men conducting regular physical exercise and consuming 3 or more dishes of vegetables per day had lower odds ratios for depressive symptoms. For women, high odds ratios for depressive symptoms and perceived stress were observed among those who tended to have salty foods (or frequent use of soy sauce) and a lower odds ratio for perceived stress was noted among persons who had soy products every day. CONCLUSION: Lifestyle facets such as skipping breakfast, low physical activity, and short sleeping time, appear to be associated with psychological health status of Japanese men and women.

Plasma fibrinogen concentrations and risk of stroke and its subtypes among Japanese men and women.

BACKGROUND AND PURPOSE: We aimed to examine the impact of fibrinogen concentrations on the incidence of stroke. METHODS: We examined the association between fibrinogen and risk of total stroke and stroke subtypes in an 11-year prospective study of 4608 men and 7589 women aged 40 to 79 years with no history of stroke and/or coronary heart disease. The analysis was repeated, stratified by smoking status, to examine whether the association between fibrinogen and stroke was modified by smoking. RESULTS: There were 317 incident total strokes comprising 103 hemorrhagic strokes (70 intraparenchymal hemorrhages [22.1% of strokes], 33 subarachnoid hemorrhages [10.4%]), 206 ischemic strokes (65.0%), and 8 strokes of undetermined type (2.5%). The multivariable hazard ratio (95% CI) for the highest versus lowest fibrinogen quartiles after adjustment for age, sex, area, and known cardiovascular risk factors was 2.5 (1.3 to 5.0), P<0.01, for hemorrhagic stroke and 3.2 (1.4 to 7.4), P<0.01, for intraparenchymal hemorrhage. There was no positive association of fibrinogen with risk of ischemic stroke or subarachnoid hemorrhage. Among never-smokers, the multivariable hazard ratio (95% CI) for the highest versus lowest fibrinogen quartiles was 3.5 (1.3 to 9.3), P=0.01, for hemorrhagic stroke and 4.4 (1.3 to 15.2), P=0.02, for intraparenchymal hemorrhage. CONCLUSIONS: High plasma fibrinogen concentration can be a predictor for risk of intraparenchymal hemorrhage.

Impact of metabolic syndrome on brachial-ankle pulse wave velocity in Japanese.

The aim of this study was to determine the effect of metabolic syndrome on brachial-ankle pulse wave velocity (baPWV) by using the new guidelines for diagnosis of this syndrome in Japan. We examined 525 men and women without a history of cardiovascular disease or cancer, and an ankle-brachial index < 0.9. The baPWV was measured using a device (Form PWV/ABI) that simultaneously monitored bilateral brachial and ankle pressure wave forms. Metabolic syndrome was defined as a waist circumference > or = 85 (90) cm in men (women) and two or more of the following risk factors: hypertension, dyslipidemia, and glucose intolerance diagnosed by a 75 g oral glucose tolerance test. The baPWV showed a significant linear relationship with waist circumference, waist-to-hip ratio, body fat, systolic and diastolic blood pressure, triglycerides, fasting glucose, 2-h-postload glucose, fasting insulin, and glycosylated hemoglobin-A1c, after adjusting for sex and age. These factors were also strongly related to fasting insulin levels. When subjects were classified into six groups based on waist circumference and the number of risk factors for metabolic syndrome (0, 1, and > or =2), we found that more risk factors clearly increased the odds ratios for an elevated baPWV in those subjects in the highest quartile of the baPWV distribution in multivariate logistic models. An increase in odds ratio was observed despite a normal waist circumference and may well have been due to increased fasting insulin and blood pressure levels. An increase in the number of risk factors for metabolic syndrome was highly correlated with an increased baPWV, probably due to insulin resistance.

Serum total homocysteine concentrations and risk of stroke and its subtypes in Japanese.

BACKGROUND: To date, no prospective studies have examined the association between serum homocysteine levels and the risk of stroke and stroke subtypes in Asian populations. METHODS AND RESULTS: A prospective, nested, case-control study of Japanese subjects 40 to 85 years of age was conducted by using frozen serum samples from 11 846 participants in cardiovascular risk surveys collected from 1984 to 1995 for one community and 1989 to 1995 for the other two communities. By the end of 2000, we identified 150 incident strokes, the subtypes of which were confirmed by imaging studies. Three control subjects per case were selected by matching for sex, age, community, year of serum storage, and fasting status. Serum total homocysteine levels were measured by high-performance liquid chromatography. Compared with control subjects, total (n=150), hemorrhagic (n=52), and ischemic (n=98) strokes had higher geometric mean values of total homocysteine and higher proportions of homocysteine > or =11.0 micromol/L. The multivariate odds ratios (95% CI) for highest (> or =11.0 micromol/L) versus lowest quartiles (<7.0 micromol/L) of homocysteine after adjustment for body mass index, smoking, alcohol intake, hypertension, serum total cholesterol, and other cardiovascular risk factors were 2.99 (1.51 to 5.93) for total stroke, 3.89 (1.60 to 9.46) for ischemic stroke, 3.36 (1.27 to 8.90) for lacunar infarction, and 1.63 (0.44 to 6.00) for hemorrhagic stroke. The respective multivariate odds ratios associated with a 5-micromol/L increase in homocysteine were 1.40 (1.09 to 1.80), 1.52 (1.07 to 2.14), 1.48 (1.01 to 2.18), and 1.10 (0.76 to 1.59). The excess risk of total and ischemic strokes did not vary significantly according to sex, age, smoking status, or hypertensive status. CONCLUSIONS: High total homocysteine concentrations were associated with the increased risk of total stroke, more specifically ischemic stroke and lacunar infarction, among Japanese men and women.

Prospective study of major and minor ST-T abnormalities and risk of stroke among Japanese.

BACKGROUND AND PURPOSE: The association between minor ST-T abnormalities and stroke incidence has not been well elucidated. We sought to examine the relationship between nonspecific minor or major ST-T abnormalities and the incidence of stroke among Japanese men and women. METHODS: A 15.4-year prospective study was conducted with 10 741 men and women aged 40 to 69 years in 4 Japanese communities. Electrocardiograms were taken at baseline and were read according to the Minnesota Code. The incidence of stroke was ascertained using systematic surveillance. RESULTS: During the 15.4-year follow-up, 602 strokes (339 ischemic strokes, 129 intracerebral hemorrhages, 80 subarachnoid hemorrhages, and 54 unclassified strokes) occurred. Both men and women with major ST-T abnormalities had approximately 3-fold higher age-adjusted relative risk and 2-fold higher multivariate-adjusted relative risk of total stroke than did those without such abnormalities. Men with minor ST-T abnormalities had a 2.3-fold higher age-adjusted relative risk of total stroke, both ischemic and hemorrhagic, than did those without such abnormalities. After we adjusted further for hypertension category, the relative risk for minor ST-T abnormalities was reduced substantially but remained statistically significant: 1.8 (95% CI, 1.3 to 2.4) for total stroke, 1.9 (95%CI, 1.3 to 2.8) for ischemic stroke, and 1.7 (95% CI, 1.0 to 3.0) for hemorrhagic stroke. For women, however, there was no relation between minor ST-T abnormalities and stroke incidence. CONCLUSIONS: Minor ST-T abnormalities have predictive value for the risk of total stroke, both ischemic and hemorrhagic, among middle-aged Japanese men, as do major ST-T abnormalities for both sexes.

Linoleic acid, other fatty acids, and the risk of stroke.

BACKGROUND AND PURPOSE: The role of serum fatty acids as a risk factor for stroke and stroke subtypes is largely unknown. METHODS: A prospective nested case-control study of Japanese 40 to 85 years of age was conducted through the use of frozen serum samples from 7450 participants in cardiovascular risk surveys collected from 1984 to 1989 for 1 community and 1989 to 1992 for the other 2 communities. By the end of 1998, we identified 197 incident strokes whose subtypes were confirmed by imaging studies. Three controls per case were selected by matching for sex, age, community, year of serum storage, and fasting status. RESULTS: Compared with controls, total (n=197), hemorrhagic (n=75), and ischemic (n=122) strokes had similar proportions of n3 polyunsaturated fatty acids, lower proportions of linoleic and arachidonic acids, and higher proportions of saturated and monosaturated acids, determined by gas chromatography. The multivariate odds ratios associated with a 1-SD increase in linoleic acid (5%) after adjustment for hypertension, diabetes, serum total cholesterol, and other cardiovascular risk factors were 0.72 [95% confidence interval (CI), 0.59 to 0.89] for total stroke, 0.66 (95% CI, 0.49 to 0.88) for ischemic stroke, 0.63 (95% CI, 0.46 to 0.88) for lacunar infarction, and 0.81 (95% CI, 0.59 to 1.12) for hemorrhagic stroke. The respective odds ratios for saturated fatty acids (4%) were 1.13 (95% CI, 1.05 to 1.65), 1.35 (95% CI, 1.01 to 1.79), 1.44 (95% CI, 1.03 to 2.01), and 1.21 (95% CI, 0.82 to 1.80). Further adjustment for other fatty acids attenuated these relations, but the relation between linoleic acid and risk of ischemic stroke remained statistically significant. CONCLUSIONS: A higher intake of linoleic acid may protect against ischemic stroke, possibly through potential mechanisms of decreased blood pressure, reduced platelet aggregation, and enhanced deformability of erythrocyte cells.

Prevalence and correlates of carotid atherosclerosis among elderly Japanese men.

We determined intima-media thickness (IMT) and diameter of carotid artery and estimated their correlations with cardiovascular risk factors in 1129 men aged 60-74 years, who participated in a cardiovascular risk survey in three Japanese communities. The multivariate odds ratios (95% confidence interval) for the maximum IMT > or = 1.1 mm in the common carotid artery (CCA) were 1.3 (1.1-1.5) per 4 years of age, 1.8 (1.4-2.5) for hypertension, 1.4 (1.2-1.7) for a 34.4 mg/dl increase in serum total cholesterol, 0.7 (0.6-0.8) for a 14.7 mg/dl increase in serum HDL-cholesterol, and 2.4 (1.1-5.0) for history of stroke, while the maximum IMT > or = 1.5mm in the internal carotid artery (ICA) were 1.6 (1.4-1.8) per 4 years of age, 1.9 (1.5-2.4) for hypertension, 1.6 (1.2-2.1) for current smoking, and 3.5 (1.6-7.6) for history of stroke. Age, height, hypertension, current smoking, ethanol intake and history of coronary heart disease were independent determinants of both the outer and inner CCA diameter. Maximum IMT correlated positively with the outer diameter and inversely with the inner diameter in the CCA. Carotid atherosclerosis suggests to be a risk factor for stroke among Japanese elderly men, although future prospective studies are required to confirm this finding.

Determinants of platelet aggregation in 50-70-year-old men from three Japanese communities.

To investigate the association of lifestyle and constitutional variables with platelet aggregation, we examined the platelet aggregation, serum fatty acid composition, alcohol intake, smoking, and dietary intake of seafood and soybean estimated by a 1-week dietary record in 448 males aged 50-70 in three rural Japanese communities: Ikawa, Akita prefecture (northeast coast), Noichi, Kochi prefecture (southwest coast), and Kyowa, Ibaraki prefecture (central inland). Platelet aggregatory threshold index (PATI) was used to determine the minimum concentration of adenosine 5'-diphosphate (ADP) that caused a non-reversible aggregation of platelets. Intake of seafood and n3-polyunsaturated fatty acid and ingestion of ethanol were higher in the northeast coastal community than in the other two communities. Mean platelet and white blood cell counts were lower in northeast coastal community than in the other two communities. The geometric mean PATI was higher (i.e. platelet aggregation was lower) in the northeast coastal community than the other two communities. Within the entire sample, platelet aggregation correlated inversely with serum level of n3-polyunsaturated fatty acids and gamma-glutamyl transpeptidase, an index of alcohol consumption, and positively with platelet and white blood cell counts. Platelet aggregation tended to correlate positively with serum arachidonic acid. There was no correlation between smoking and platelet aggregation. Our results suggest that seafood intake and moderate alcohol consumption reduce platelet aggregation.

One-year community-based education program for hypercholesterolemia in middle-aged Japanese: a long-term outcome at 8-year follow-up.

To examine a long-term effect of community-based education program for hypercholesterolemia and an effect modification by apolipoprotein E polymorphism, we conducted a 1-year randomized clinical trial with 8 year-follow-up. One hundred four persons aged 40-64 years who had serum total cholesterol levels between 6.21 and 7.73 mmol/l (240 and 299 mg/dl) in 1988-89 cardiovascular risk surveys were enrolled in the trial. The intervention group (n=51, 82% for women) attended eight education classes in 1 year, while the control group (n=53, 85% for women) attended only two classes. Both groups were invited to the subsequent annual surveys. The mean serum cholesterol was 0.24-0.26 mmol/l less in the intervention than in the control group at both 6 month and 1 year (P=0.03, each) while the proportion of subjects using hypolipidemic agents was 0 and 6% in both groups, respectively. During 8-year follow-up, the probability of using hypolipidemic agents and/or total cholesterol > or =7.76 mmol/l was 51% in the education group and 69% in the control group; the risk ratio in the intervention vs control groups was 0.62 (95% CI: 0.36-1.06). When stratified by the apolipoprotein E polymorphism examined for 78% of the subjects, the risk ratio was 0.61 (0.31-1.18) among subjects without e4 allele (n=59) and 0.55 (0.14-2.14) among those with e4 allele (n=22). The intervention group had reduced intake of egg, fish egg, butter, mayonnaise and fatty meat compared to the control group at 6-month, 1- and 8-year follow-up. In conclusion, our community-based program was effective in reducing serum total cholesterol levels non-pharmacologically during the first year, and also reduced the likelihood of progressive worsening of hypercholesterolemia during the subsequent 8 years, regardless of the apolipoprotein E polymorphism.

Trends in the incidence of coronary heart disease and stroke and the prevalence of cardiovascular risk factors among Japanese men from 1963 to 1994.

PURPOSE: To determine trends in the incidence of cardiovascular disease in Japan, we examined observational data on coronary heart disease, stroke, and cardiovascular risk factors among urban Japanese working men. SUBJECTS AND METHODS: The surveyed population included all male employees aged 40 to 59 years who worked for eight industrial companies in Osaka, the second largest metropolitan city in Japan. Surveillance for cardiovascular disease and risk factors was conducted from 1963 to 1994. RESULTS: The age-adjusted incidence of coronary heart disease increased from 0.4 per 1000 person-years during 1963 to 1970, to 1.5 per 1000 person-years during 1979 to 1986, and then plateaued until 1987 to 1994 (P for trend = 0.002), whereas the incidence of stroke declined from 1.2 per 1,000 person-years during 1971 to 1978, to 0.6 per 1,000 person-years in 1987 to 1994 (P for trend = 0.02). The age-adjusted mean (+/- SD) total cholesterol level, which was 4.87 +/- 2.88 mmol/L during 1963 to 1966, increased to 5.11 +/- 0.62 mmol/L during 1982 to 1983 (P <0.001), and 5.09 +/- 0.75 mmol/L during 1990 to 1991. Both mean systolic and diastolic blood pressures increased by 1 mm Hg between the periods of 1966 to 1967 and 1982 to 1983, and declined below the 1966 to 1967 levels during 1990 to 1991. The prevalence of smoking declined from 72% during 1975 to 1976, to 58% during 1990 to 1991 (P for trend <0.001). CONCLUSION: Although these findings were limited to urban middle-aged men, the increase in serum cholesterol is likely to attenuate the reduction in future rates of coronary heart disease in Japan that would have been expected to result from the declining prevalence of smoking.