And increasingly, Okinawans are dying of the cardiovascular disease (CVD) that such eating habits often herald. Feeling pain in his shoulder and chest, Miyagi last August checked himself into a local hospital, where a nurse gave him an electrocardiogram (ECG) to test for possible heart problems. "When she tore the paper from the ECG machine and ran off," he says, "I knew something was wrong." Miyagi had suffered a massive heart attack that would require three balloon angioplasties and hospitalize him for more than three months. Since his recovery he's changed his lifestyle, exercising regularly and eating more healthily—but he's setting an example that too few are following. "For every 100 patients I tell to lose weight, maybe one of them will be successful," says Dr. Kiyoshi Takashiba, Miyagi's cardiologist. "I tell them about the possible risks to their health, about diabetes and heart disease, but it seems so far off. They don't see it as something that relates to them."
That's been the attitude of most Asians toward heart disease: it's a problem for rich Westerners supersizing themselves to death. Asia's health worries were the age-old problems of infectious disease, famine and malnutrition. But on the road to modernization, a large proportion of Asians—not just Okinawans—are trading healthy traditional diets for fattier foods, physical jobs for deskbound sloth, the relative calm of the countryside for the stressful city. Heart-attack victims like Miyagi are just the first wave of a swelling population of Asians with heart problems.
If you're not convinced, here are a few statistics to make your ticker skip a beat: while deaths from heart attacks have declined more than 50% since the 1960s in many industrialized countries, 80% of global CVD-related deaths now occur in low and middle-income nations—which covers most countries in Asia. In India in the past five decades, rates of coronary disease among urban populations have risen from 4% to 11%. In urban China, the death rate from coronary disease rose by 53.4% from 1988 to 1996. A report released last week by the Earth Institute at Columbia University warned that without sustained effort on individual and national levels, the coming heart-disease epidemic will exact a devastating price on the region's physical and economic health. "I think we're going to see a huge increase in heart disease and stroke, and that will lead to all sorts of problems," says Professor Philip Poole-Wilson, president of the World Heart Federation. "We're trying to warn people sufficiently early so that they can do something about it, but this isn't a disease you can cure by turning on an electric switch."
The good news is that risk can be greatly reduced with a mix of lifestyle modifications and medical treatment. Most of us are aware that eating a lighter, more balanced diet, quitting tobacco and exercising regularly are enough to head off most cases of heart disease before they ever happen. For those who can afford it, better treatments and medicines are also increasingly effective in curbing the high blood pressure and elevated cholesterol levels that lead directly to cardiovascular disease. These advances are turning what was once an eventual death sentence into a manageable condition. But in much of Asia, the best that medical science has to offer is either unavailable or is too expensive for most people. That makes education and prevention programs all the more urgent. "Prevention can be done, it should be done, and this is the right moment to put every effort into it," says Dr. T.F. Tse, a leading Hong Kong cardiologist. "Otherwise, the result would be unthinkable."