This review paper presents trends in mortality from coronary heart disease (CHD), trends in incidence of CHD, and trends in CHD risk factors among Japanese since the 1960s. These trends are relevant in view of the rapid changes in lifestyle habits observed in this population. The decline in CHD mortality, when paired with an increase or no change in CHD incidence (which nevertheless remained low), could be explained by improvements in medical treatment for CHD and/or decreased severity of CHD during the last decades.