Trends in coronary heart disease mortality and related factors in Israel.

Age-adjusted mortality from coronary heart disease (CHD) showed a striking decline in Jews living in Israel between 1974 and 1979. The decline was evident for both males (age-adjusted rate, age 25+, declining from 441 to 347/100,000) and females (declining from 303 to 205/100,000, respectively), and probably for each of the different immigrant groups. A similar decline in Arabs and Druse has not been identified and awaits further analysis. The decline has been associated with the presentation of coronary care units, coronary bypass surgery, improved emergency service and cardiopulmonary resuscitation procedures. The modernization of diagnostic procedures, discharge and rehabilitation, and possibly pharmacologic therapy may also have contributed, but available data do not provide unequivocal proof for the role of secondary prevention. In the realm of primary prevention, evidence for improved screening, treatment and control of hypertension is suggestive but not conclusive. Little, if any, change in serum cholesterol levels and cigarette smoking habits has been observed. A continuous increase of the percent of calories derived from fat has been apparent, while energy derived from carbohydrates, notably starch, has been declining. Thus, changes in CHD mortality were not accompanied by putatively anti-atherogenic trends in eating habits. The reasons behind the striking decline of CHD mortality in Israel are not clear, but so far there is very little in the available data to suggest a meaningful effect of life-style modifications on mortality trends.