The life expectancy of a person born in Japan is among the highest in the world (82.9 years) yet tobacco smoking and high blood pressure are still the major risk factors for death among adults in Japan, emphasizing the need to reduce tobacco smoking and to improve ongoing programs designed to help people manage multiple cardiovascular risk factors, including high blood pressure, according to a study published in this week's PLoS Medicine.

In an analysis of available data led by Nayu Ikeda from the University of Tokyo in Japan, the authors found that in Japan in 2007, tobacco smoking and high blood pressure accounted for 129,000 and 104,000 deaths, respectively, among adults aged 30 years and over. Physical inactivity accounted for 52,000 deaths, high blood glucose and high dietary salt intake accounted for 34,000 deaths each, and alcohol use for 31,000 deaths. Furthermore, the authors found that life expectancy at age 40 would have been extended by 1.4 years for both sexes, if exposure to multiple cardiovascular risk factors had been reduced to an optimal level.

According to the authors, in order to sustain the trend of longevity in Japan for the 21st century, additional efforts in a variety of fields are required for decreasing adult mortality from chronic diseases and injuries. They say: "A first step will be to powerfully promote effective programs for smoking cessation."

Tobacco smoking is deeply rooted in Japanese society, but the authors argue that health professionals can play a big role: "Health care professionals, including physicians, who are highly conscious of the harms of tobacco will play the primary role in treatment of smoking and creating an environment for implementation of stringent tobacco control policies.

As for high blood pressure, the authors say: "it is urgent to establish a monitoring system for management of high blood pressure at the national level. Further investigation through national health surveys will help understand factors that contribute to the inadequate control of blood pressure in the Japanese population."

The authors conclude: "Measuring the quality of the care that is actually delivered by interventions will be of paramount importance in the assessment of current policies and programs for the treatment of multiple cardiovascular risks including hypertension. These concerted actions in research, public health, clinical practice, and policymaking will be the key for maintaining good population health in the aging society."