Changes in ischemic findings in ECG, obesity and serum lipids and the relations among them were investigated in Sada Town, a typical agricultural and mountaineous area in Shimane Prefecture, where the mortality rate from ischemic heart disease had increased. Compared with 1983, the percentage of ischemic findings in ECG in 1990 increased, and a marked elevation of total serum cholesterol level, and relative and absolute lowering of HDL cholesterol level were observed in 1990. By observing the relations of total serum cholesterol, HDL cholesterol and the atherosclerotic index to the ischemic findings in electrocardiograms (ECG), it was found that males showed a significantly lower HDL cholesterol level and higher atherosclerotic index than the control group. In males, a relation between obesity and ischemic findings in ECG was observed. In females, a relation between obesity and the atherosclerotic index was observed; however, no relations were observed between ischemic findings and obesity. These results support the hypothesis that a marked elevation of the total serum cholesterol level, relative and absolute lowering of the HDL cholesterol level and obesity have an effect on the recent increase of male deaths due to ischemic heart disease in Sada Town, Shimane Prefecture.