Lifestyle, serum lipids and coronary artery disease: comparison of Japan with the United States.

Westernization of the Japanese lifestyle has been steadily progressing, and the percent energy intake as fat has increased 3.8 fold over the past 50 years. Although the serum cholesterol (C) level has also increased, the death rate due to coronary artery disease (CAD) is not increasing. Consumption of dietary fat in the United States (US) is decreasing and serum C levels are also decreasing. Although the death rate due to CAD is markedly decreasing in men and women in the US, it is still 4 times higher than that of Japanese. The percent energy intake as fat in Japanese migrants to the US (Japanese-American: JA) lies between that of native Japanese and US populations, and their C values are higher than those of native Japanese. Compared with native Japanese, JA showed a significant increase in carotid intima-media wall thickness, and deaths from CAD are also higher than those of Japanese in Japan. Although the death rate due to CAD has not yet increased in Japan, Japanese have the potential for further progression of atherosclerosis and increasing CAD.