Myocardial infarction occurrence in Jerusalem: a Mediterranean anomaly.
BACKGROUND
The Jewish population of Israel consumes a diet rich in polyunsaturated fatty acids with a relatively low proportion of saturated fat, has a small alcohol intake and a lipid profile characterized by low HDL-cholesterol and high lipoprotein(a) (Lp(a)). It is therefore of interest to compare occurrence rates of coronary heart disease (CHD) with those elsewhere.


METHODS
The community-based event rate of CHD [comprising acute myocardial infarction (AMI) and CHD death] and case-fatality was determined in 1995-1997 by active surveillance among Jewish residents of the Jerusalem District aged 25-64 according to standardized WHO-MONICA criteria. We compared our findings with rates among MONICA populations in 21 countries. Twelve hundred and six events occurred in Jerusalem during approximately 399,000 [correction] person-years (930 non-fatal AMI and 276 CHD deaths).


RESULTS
The age-adjusted incidence of CHD ranked high compared with the 21 countries (men third highest, women eighth highest), far exceeding the Mediterranean countries. In contrast, the pre-hospital mortality rate was low, similar to countries in the Mediterranean basin, and the 28-day case fatality was remarkably low, far lower than for any MONICA population in men, and second lowest in women. Correspondingly, the incidence of non-fatal AMI ranked extraordinarily high (men first, women third). The low case-fatality ranking persisted upon adjustment for treatment differences between populations.


CONCLUSIONS
We report an unusual combination of a high incidence of CHD among Jewish residents of Jerusalem accompanied by extraordinarily low case fatality, the latter suggesting reduced susceptibility to lethal arrhythmias. Determinants of this anomaly require clarification.
Kark
Jeremy D
JD
Epidemiology Unit, Hadassah Medical Organization and Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem 91120, Israel. jeremy1@vms.huji.ac.il
Goldberger
Nehama
N
Fink
Rita
R
Adler
Bella
B
Kuulasmaa
Kari
K
Goldman
Sylvie
S
D000328:Adult; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index; D014944:World Health Organization