Making A Dent In Heart Disease

Jerusalem — The percentage of Israelis dying from cardiovascular disease has plummeted during the past two decades, two analyses show, and heart experts attribute the good news to a combination of improved education, better medical care and lifestyle changes.

A 2016 statistical analysis of cardiovascular deaths over a 15-year period by two Hadassah Medical Center cardiologists — Dr. Mervyn Gotsman and his son Dr. Israel Gotsman — found that between 1998 and 2012 heart-related deaths fell from 162 per 100,000 residents to 80 per 100,000 residents — a whopping 50 percent drop. “We knew there was a reduction, but we didn’t expect it to be this profound,” Israel Gotsman told The Jewish Week. The number is all the more significant, he said, when compared to other causes of death, including cancer, “where the rates haven’t gone down very much.”

In their report “The Plunging Mortality of Cardiovascular Disease in Israel,” the Gotsmans assert that Israel’s success in fighting heart disease can serve as a “trajectory of improvement” for other countries.

The physicians give credit to a variety of sources, including the Israel Heart Society for its national campaigns against smoking, hypertension and obesity, its educational push for lifestyle changes and the liberal use of statins to fight high cholesterol.

They also credit the “very early” treatment of acute myocardial infarction, generally within two hours of the onset of pain, thanks to the close proximity of Israeli hospitals even in rural areas and specialized intensive care units in all regional hospitals.

In Israel “all medical centers have the expertise to do cardio catheterizations, which open arteries, as soon as possible, 24/7,” Gotsman noted.

The researchers also credit the use of new anticoagulants, the careful management of cardiogenic shock, the use of a new generation of stents, percutaneous coronary angioplasty for patients with “significant” coronary artery disease; the “judicious” use of coronary artery bypass grafting, pacemakers and implantable defibrillators and early corrective surgery for congenital heart disease.

Gotsman said the access to affordable universal healthcare provided by Israel’s health funds — similar to HMOs — is another factor in the decrease of heart disease.

The cardiologist emphasized that Israel’s drop in heart disease is part of a worldwide trend, but that according to a 2016 statistical analysis of cardiovascular mortality in OCED countries, Israel is among the top four countries that have more than halved heart-related mortality rates.

The OCED (Organisation for Economic Co-operation and Development) is an intergovernmental economic organization with 35 democratic member states. According to the organization, Israel experienced a 68 percent reduction in cardiovascular disease deaths from 1990-2013 — a 23-year period.

“If you look at the average decline in cardiovascular mortality in OCED countries it’s about 45 percent, so Israel is definitely leading the way along with Denmark, the Netherlands and Norway,” Gotsman said.

Donna Zwas, director of the Linda Joy Pollin Cardiovascular Wellness Institute at Hadassah Medical Center in Jerusalem, noted that cardiovascular mortality for Israeli men is the lowest in the world and that women enjoy the fourth lowest heart-related mortality rate.

That, she believes, has contributed to the rise in Israeli longevity, among the highest in the world.

Zwas said Israel is a “tiny country” and that everyone is “less than an hour away from a major medical center that can open an artery. It’s not like rural Oklahoma, where it takes a helicopter to get to a hospital in time.”

Once an Israeli enters an emergency room it takes an average of just 91 minutes until his or her artery is cleared and blood flow is resumed.

“At Hadassah we have an agreement with Magen David Adom” — Israel’s national ambulance corps — “to bypass the ER” and go straight to the cardiology department, she said.

Zwas said the Israeli government and bodies like her Heart Wellness Institute are putting a lot of resources into preventive care.

Founded four years ago, the Wellness program includes a multidisciplinary cardiovascular clinic for women with an emphasis on lifestyle change, an internet site and social media center including Facebook, Instagram and Twitter, and multiple culturally-appropriate community intervention programs on a large scale. Target populations for community interventions include Arab women in east Jerusalem, ultra-Orthodox women, the disabled community (men and women), disadvantaged women and hospital employees. The center is also involved in research, healthcare provider education and public awareness.

Michael Glikson, head of the Israel Heart Society, believes speedy treatment is the overriding factor in reducing heart-related mortality.

“Time is muscle. If you intervene early, you save heart muscle and that reduces the Israeli mortality.” (The mortality rate one month after the [heart event] is 4 percent.)

“That’s a very low mortality rate and less than half of what it was 20 years ago. That’s a great achievement of our acute care system,” said Glikson, a cardiologist and director of the Arrhythmia Center at Sheba Medical Center.

Glikson also cited Israelis’ “relatively healthy” diet, increasing health awareness, outdoorsy lifestyle and the fact that most Israelis lack the genetic risk factors related to serious heart disease.

“Many people consume a Mediterranean diet” based heavily on olive oil, vegetables and protein. People tend to exercise and there’s been a decrease in smoking. We do however have diabetes and some other issues,” Glikson said. “We still have a lot of work to do but we’re improving our heart behavior.”