title: Myocardial infarction occurrence in Jerusalem: a Mediterranean anomaly.
abstract: 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.
authors.affiliation: 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
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Kark
authors.forename: Nehama
authors.initials: N
authors.lastname: Goldberger
authors.forename: Rita
authors.initials: R
authors.lastname: Fink
authors.forename: Bella
authors.initials: B
authors.lastname: Adler
authors.forename: Kari
authors.initials: K
authors.lastname: Kuulasmaa
authors.forename: Sylvie
authors.initials: S
authors.lastname: Goldman
mesh_terms: 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