Honolulu Heart Program

The Honolulu Heart Program (HHP) is a prospective cohort of 8,006 Japanese American men living in Oahu, Hawaii, born between 1900 and 1919 (45 to 68 years old at the time of enrollment). The main objective of the HHP was to identify risk factors for cardiovascular and cerebrovascular disease. The HHP started in 1965 and was funded by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health. The HHP is part of a larger study called the NI-HON-SAN study, which stands for Nippon, Honolulu, and San Francisco. The NI-HONSAN study included men of Japanese ancestry born in the same period as the HHP who were living in Japan and San Francisco.

By observing Japanese Americans who had immigrated to Hawaii, the study investigators could examine different environmental, cultural, and lifestyle risk factors associated with the development of cardiovascular and cerebrovascular disease. Previous studies had revealed geographic variation in the prevalence and incidence of cardiovascular disease and stroke. The study participants were the same ethnically, but the Japanese American men had adopted a Western lifestyle. The investigators were able to reduce genetic variability and focus on factors related to immigration [Page 503]that may be associated with the difference in cardiovascular and cerebrovascular disease incidence and prevalence.

At enrollment, the HHP participants were given a complete physical examination and received repeated follow-up examinations during the study period. The baseline examination (1965–1968) included collection of the following clinical data: blood pressure, resting heart rate, vital capacity, body mass index, serum cholesterol, triglyceride, glucose, hematocrit, uric acid, and urine. The men also provided demographic and lifestyle (smoking, alcohol consumption, diet, and physical activity) information.

The Japanese American men were found to have diets higher in animal protein and saturated fat as well as higher levels of serum cholesterol, triglyceride, uric acid, and glucose than Japanese men in Japan. The Japanese American men had higher rates of coronary heart disease than Japanese men in Japan, but the prevalence of cerebrovascular disease was lower in the HHS cohort than in the Japanese cohort. The investigators identified the following as risk factors for coronary heart disease: hypertension; higher levels of hematocrit, serum cholesterol, triglyceride, uric acid, and glucose; obesity; smoking; lower alcohol consumption; less physical activity; and lower lung function.

Since the study started, the following data have been collected on the participants: hospital discharges, death certificates, and autopsy records for morbidity and mortality due to coronary heart disease, cancer, and stroke. Surveillance of morbidity and mortality in the original cohort is still ongoing. The HHP provides a rich data source for researchers. From 1993 to 1996, the National Institute of Aging studied aging and dementia in the HHP cohort. Some examples of recent findings based on the HHP data include findings that magnesium is protective against heart disease, reduced caloric diet lengthens the life span, and older men can increase longevity by walking at least 2 miles per day.