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14 Secrets From Countries With the Lowest Heart Attack Rates

Japan, 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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What is the heart attack rate in the United States?

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 suggest that there's room for improvement when it comes to lowering the risk of heart disease, both in the US and other parts of the world with higher heart attack rates. Here's what you can learn from the countries with lower heart attack rates, and what you might do differently to lower your own risk.

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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."

KimchiYeo Jung Kim/Shutterstock

They eat fermented foods

No Korean meal is complete without a side dish (or two) of kimchi. A higher intake of fermented food has been widely praised by nutrition experts: According to Ornish Lifestyle Medicine, "Fermented foods reduce inflammation, improve immunity, digestion and gut health, support weight loss by enhancing metabolism, improve mental health, and even reduce the risk of heart disease." (You may also want to avoid 13 foods cardiologists never eat.)

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They choose green tea over coffee

Green tea is loaded with antioxidants, which research 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." Don't miss the other health benefits of green tea that you haven't heard before.

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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 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.

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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 US. 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."

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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.

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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 healthier in comparison to other nations that have more heart disease. 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.

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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."

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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.

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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 normal weight. If you want to take a cue from these cultures, take the time to savor your meal. Studies have indicated that eating fast may lead to eating more, which in turn leads to greater obesity rates.

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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."

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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 for 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."

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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.)

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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 Studies shows that smoking, obesity, happiness, and even loneliness are contagious. So the social networks of long-lived people have favorably shaped their health behaviors." Don't forget to check out these 30 ways to reduce your risk of heart disease.

Sources
Medically reviewed by Oscar H. Cingolani, MD, on January 21, 2020