14 Secrets from Countries with the Lowest Heart Disease Rates
Updated: Mar. 17, 2022Japan, Korea, and France have some of the lowest rates of heart disease in the world. Learn their heart-healthy habits to tack on years to your life.
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Which countries have the lowest rate of heart disease?
Not only is heart disease the leading cause of death in the United States, but about every 40 seconds someone has a heart attack. These rates from the Centers for Disease Control and Prevention (CDC) suggest that there’s room for improvement when it comes to lowering the risk of heart disease, both in the United States and other parts of the world with higher heart attack rates. Reports from the United Nations and the Organisation for Economic Cooperation and Development (OECD) indicate that Japan, Korea, and France are countries with the lowest heart disease rates. Here’s what we can learn from the way these countries live.
They eat smaller portions
Overeating is less of a problem in Japanese culture due in part to the nature of their workday. Having to rise early to commute to work and return late means meals on the run and in smaller portions. Portion control is also ingrained in the culture, according to Theodore Takata, MD, a clinical cardiac electrophysiologist at Texas Health Fort Worth, “Following a particularly good meal, the Japanese use the phrase ‘Hara Hachi Bu.’ This phrase simply means 80 percent, as in 80 percent full. At 100 percent, a person is said to feel uncomfortable and stuffed.”
They eat fermented foods
A Korean meal would be incomplete without a side dish (or two) of kimchi—one of the best probiotic foods your diet needs. A higher intake of fermented food is associated with a lower risk of heart disease in women, according to research in the Journal of Nutrition. And research in PLoS One found that probiotics, like those found in fermented foods, might also lower LDL cholesterol. (You may also want to avoid 13 foods cardiologists avoid.)
They choose green tea over coffee
Green tea is loaded with antioxidants, which research in Nutrition, Metabolism, and Cardiovascular Diseases suggests can lower blood pressure and cholesterol. And while most Americans reach for the coffee machine on instinct, people in Japan more often opt for tea. Claire Koga, MD, a family physician and board member of Keiro, a non-profit health group, points out: “Japanese consume large amounts of tea, particularly green tea. Several studies have shown that antioxidants, specifically flavonoids found in green and black teas, may protect the heart in part by improving endothelial function—and this can reduce the risk of clogged arteries.”
They eat a lot of fish
It’s no secret that fish is good for you. But getting as much in your daily diet as some people in Japan and other countries with the lowest heart disease rates do may help boost your lifespan. The secret lies not in fish’s protein and vitamin D (added bonuses), but the omega-3 fatty acids. “The number one explanation [of great heart health] is the greater consumption of fatty fish rich in omega-3 fatty acids such as EPA and DHA. This can be measured by the AA/EPA ratio in the blood, which is seven times lower than Americans,” says Barry Sears, MD, author of the Zone Diet book series and president of the Inflammation Research Foundation.
They don’t spend too much time sitting down
TV is less present in both French and Japanese culture, which may contribute to their lower death rate in a given time period compared with people in the United States. The stats appear to back this up: In a Canadian Fitness survey, those who stood most of the day had a 33 percent lower mortality during the study period than those who sat. According to Dr. Takata, “Using hours of television watched per week as a surrogate for sitting—people can remember how much television watched in a week more easily than how much time they sat—one study demonstrated that every single hour of television watched after the age of 25 years reduces the viewer’s life expectancy by 21.8 minutes.”
They drink alcohol moderately
People who want to live longer may want to avoid too much alcohol. In his book, The Blue Zones Solution, Dan Buettner shares the healthy habits of several enclaves of long-lived populations around the world. Most notably, these people drink alcohol moderately. He writes, “Moderate drinkers outlive non-drinkers. The trick is to drink one to two glasses per day… with friends and/or with food. And no, you can’t save up all weekend and have 14 drinks on Saturday.” A systematic review of research published in the BMJ also shows light to moderate drinking is associated with a reduced risk of cardiovascular disease.
They choose red wine
Take a stroll down Champs-Élysées, and you’ll easily be able to spot Parisians at a café sipping wine. Yet, the French population is reportedly one of the countries with the lowest heart disease in comparison to other nations. This strange phenomenon, dubbed the French Paradox, has baffled researchers for a long time. The exact reason for the country’s lower rate of heart troubles is unclear, but researchers believe that their red wine intake may contribute in part to a heart-smart diet. According to a 2017 review in the American Heart Association’s journal, Circulation, studies show an association between wine intake and a lower risk of dying from heart disease. (Although the study authors note that the research has been mixed on whether a specific type of alcohol is better than the others when it comes to possible cardiovascular protection.) Pair your glass of vino with the best foods to eat to avoid clogged arteries.
They walk everywhere
The world’s longest-lived people aren’t focused on pumping iron, running marathons, or joining gyms. Instead, they live in environments that encourage and support activity. In France, Japan, and Korea, driving (especially in major cities) is less common. Instead, people frequently walk, bike, or take public transportation. “Moving naturally refers to remaining active during the course of daily activities,” notes Dr. Takata. “Unlike in the States, most travels in these countries require walking several blocks to the train station, transfers at large train stations, and more walking once the destination is reached.”
They eat less red meat
Bacon and hamburgers are very American, but cutting red and cured meat from your diet just may lower your risk of heart disease. According to Dr. Koga, Japanese people tend to eat less meat than people in Western nations. They tend to get their proteins from lean meats or vegetable sources, which contributes to lower cholesterol and a decreased risk of coronary heart disease.
They keep an eye on their weight
According to OCED data, South Korea and Japan have the lowest obesity rates in the world (with only about 4 percent of the adult population being obese). As the American Heart Association points out, overweight people are 32 percent more likely to develop cardiovascular disease in their lifetime compared to people at a normal weight. If you want to take a cue from these countries with the lowest heart disease rates, take the time to savor your meal. Research in Obesity Facts indicates that eating fast may lead to eating more, which in turn leads to greater obesity rates. Here are some other heart disease facts you should be keeping your eye on, too.
They take time to relieve stress
Zen is an important concept in both Korean and Japanese philosophy, which encourages stress reduction through meditation. According to Buettner, “Stress leads to chronic inflammation, [which is] associated with every major age-related disease. What the world’s longest-lived people have that we don’t are routines to shed that stress. Okinawans take a few moments each day to remember their ancestors, Adventists pray, Ikarians take a nap, and Sardinians do happy hour.”
They smoke less
We all have different lifestyles, but a bad heart may be a sign that you’re smoking too much. Many people point to Japan’s steadily declining rate of smoking as one contributing factor to their rising life expectancy. According to Dr. Koga, “Smoking rates, especially among men, have declined substantially in Japan since the 1960s when the vast majority of men smoked. When one quits smoking, that person’s risk of heart disease decreases greatly compared to that of a smoker.”
They have lots of preventive care
Doctor visits are still key to preventing future heart problems, Dr. Koga says. “Preventive care is frequently practiced in Japan, and Japanese health care providers are more likely to catch problems early on when they can be more easily treated and/or managed. Annual comprehensive physical exams are quite common as well. The government and employers often encourage their employees to adopt healthier behaviors based on the results of these annual exams.” (Check out the heart health tips that cardiologists always follow.)
They maintain tight social networks
Want to lengthen your lifespan? This one may be the easiest of them all: Keep your friends. Buettner notes, “The world’s longest-lived people chose—or were born into—social circles that supported healthy behaviors. Okinawans created ‘moais’–groups of five friends that committed to each other for life. Research from the Framingham Heart Studies found that smoking, obesity, happiness, and even loneliness are contagious. So the social networks of long-lived people have favorably shaped their health behaviors.” Now that you know the secrets from countries with the lowest heart disease rates, don’t forget to check out how heart disease is different for women.
- OECD Health Statistics: "OECD Health Statistics"
- World Health Organization: "World Data Table Cardiovascular Diseases"
- Theodore Takata, MD, a clinical cardiac electrophysiologist at Texas Health Fort Worth
- Ornish Lifestyle Medicine
- Claire Koga, MD, a family physician and board member of Keiro, a non-profit health group
- Barry Sears, MD, author of the Zone Diet book series and president of the Inflammation Research Foundation
- The British Journal of Sports Medicine: "Television viewing time and reduced life expectancy: a life table analysis"
- The Blue Zones Solution, Dan Buettner
- BMJ Heart: "The French paradox: lessons for other countries"
- American Heart Association Journals: "Wine and Cardiovascular Health A Comprehensive Review"
- American Heart Association News: "Overweight, obese people risk heart disease at younger ages"
- Organization for Economic Co-operation and Development: "Top Stories"
- Obesity Facts: "Associations among Obesity, Eating Speed, and Oral Health"
- Framingham Heart Study: "Selected Research Results"
- BMJ: "Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis."
- PLoS One: "Effect of probiotic Lactobacillus on lipid profile: A systematic review and meta-analysis of randomized, controlled trials"
- Journal of Nutrition: "Total Fermented Dairy Food Intake Is Inversely Associated with Cardiovascular Disease Risk in Women"
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