A healthy cardiovascular system, with minimal arteriosclerosis, good endothelial function and well-compensated ventricular function has been observed at advanced ages, and linked to a healthy lifestyle. This has consisted of a plant-based diet, low in salt and fat, with monounsaturates as the principal fat. Other healthy lifestyle factors include regular physical activity (farming and traditional dance) and minimal tobacco use. The associated negative risk factors are low homocysteine, healthy cholesterol profile (Total:HDL ratio less than 3.5) and reasonable blood pressures throughout the life cycle. Hormone-dependent cancers including breast, ovary, prostate and colon and osteoporotic complications, such as hip fracture rates, are also less frequent compared to the west. Protective factors may include high anti-oxidant consumption, mainly flavonoids and carotenoids, through a high vegetable (e.g., onions) and soy intake. Related biological observations include low lipid peroxide, high superoxide dismutase activity and high serum hydroxyproline, a marker of bone formation. Dehydroepiandrosterone (DHEA) and its hormonal byproducts testosterone and oestrogen appear to be high in Okinawan serum compared with age-matched Americans, possibly reflecting a slower age-associated decline in the sex hormone axis in Okinawans. This may be linked to better cardiovascular and overall health. Further study is needed to delineate the reasons behind the impressive cardiovascular and overall health of the Okinawans.