Comprehensive Risk Management for the Prevention of Cerebro- and Cardiovascular Diseases in Japan

Abstract

 The leading cause of mortality in Japan is cancer. However, when cardiovascular disease, the second leading cause of mortality, and cerebrovascular disease, the fourth most common cause, are combined as vascular disease, they account for almost as many deaths as cancer. Thus, preventions of cancer and vascular disease are extremely important health-care priorities in Japan. Cerebrovascular disease and cerebral hemorrhage in particular became overwhelmingly widespread in Japan in the 1960s. Guidance for improving lifestyle habits, such as sodium intake restriction, was successful in markedly reducing blood pressure and mortality rates, a proud time in history for preventive medicine. However, in recent years, despite decreases in the main coronary risk factors, hypertension incidence and smoking rates, the mortality rate for heart disease continues to rise. Furthermore, the mortality rate for cerebral infarction has not decreased and in fact has surpassed that of cerebral hemorrhage to exhibit a Western disease pattern.

 The Hisayama study in Japan, an ongoing epidemiological research, also suggests that obesity, diabetes, and dyslipidemia now contribute more to cerebrovascular disease risk compared to past two decades. Accordingly, it is well recognized that in addition to blood pressure, the management of obesity, diabetes, and dyslipidemia, as well as chronic kidney disease (CKD), is pivotal for the prevention of cerebro- and cardiovascular diseases in Japan. Thus, methods of treatment and treatment guidelines are frequently updated for these diseases and physician specialists are well informed about them. However, some inconsistencies in the expressions used in these guidelines have been reported by general physicians.

 There has been a growing momentum for mainly academic societies to engage in scientific research on such risk factors to develop comprehensive cerebro- and cardiovascular disease management guidelines. Therefore, 11 societies including the Japanese Society for Internal Medicine agreed to participate in creating a "Comprehensive Risk Management for the Prevention of Cerebro- and Cardiovascular Diseases in Japan." The Japan Medical Association and the Japanese Association of Medical Sciences, which approved cooperative work, also participated in this project, thereby enabling the creation of this practical management chart for general practitioners. Although the basic aim was to improve risk factors (obesity, blood pressure, blood glucose, serum lipids, kidney function, etc.) by comprehensive management of lifestyle habits as the basic concept is indicated in Figure 1, the importance of comprehensive management, including drug intervention, is emphasized in the case of multiple risk factors involved in each disease. Physicians must also keep in mind that in cases with genetic factors or in secondary disease groups, specific pharmacotherapy for the underlying disease is necessary.

 It is most anticipated that this management chart will be utilized in medical settings throughout Japan and that comprehensive management of the diverse range of risk factors observed in individual patients will improve the prevention of cerebro- and cardiovascular diseases, thereby leading to a healthier society.

 Japan has one of the highest overall life expectancies and thus physicians must recognize that cerebro- and cardiovascular diseases are more likely to occur in elderly patients. Of course, management must also take into account functional declines specific to the elderly (decreased renal function and muscle weakness in particular), but careful management should also be implemented due to the greater risks of cerebro- and cardiovascular diseases in elderly individuals. We would like to introduce the comprehensive risk management chart for prevention of cerebro- and cardiovascular diseases.