ss=""h4"">BackgroundOver the past few decades, a sizable monotonous decrease in coronary heart disease (CHD) mortality rates was evident in Israel. Our purpose was to evaluate the association of risk factor time trends with this decline.ss=""h4"">Subjects and methods
Data of two Israeli male cohorts with an inception date separated by 14 years were combined: (a) 9699 employees who participated in the Israeli Ischemic Heart Disease (IIHD) project, followed-up between 1965 and 1983, and (b) 1745 participants of the Glucose Intolerance, Obesity and Hypertension (GOH) study, sampled from the Central Population Registry, followed-up between 1979 and 1997.
ss=""h4"">Results
The mean age of both groups was comparable (52.9 vs. 51.2 years in the GOH and IIHD, respectively). Systolic blood pressure (133.5 vs. 138.1 mm/Hg), smoking (44 % vs. 49 % ), and BMI (25.5 vs. 25.9 kg/m<sup>2sup>) were lower in the GOH, whereas mean serum cholesterol was higher (215 vs. 208 mg/dL). During the follow-up period, 3,173 deaths were recorded. Of these, 968 (31 % ) were attributed to CHD. Overall mortality, adjusted by age and ethnic origin, was lower in the GOH (HR = 0.80, 95 % CI: 0.72–0.89). CHD mortality was remarkably lower (HR = 0.55, 95 % CI: 0.44–0.69). Adjusting for systolic blood pressure and smoking increased the HR for CHD death to 0.68 (95 % CI: 0.55–0.85), whereas further adjustment for cholesterol reduced it slightly (HR = 0.63, 95 % CI: 0.50–0.78).
ss=""h4"">Conclusion
Traditional risk factors appear to play a limited role in the declining rates of CHD mortality among Israeli males.