Current Cardiovascular Risk Reports

, Volume 6, Issue 5, pp 363–371

Coronary Heart Disease and Metabolic Risk Factors in Israel: Focus on Gender and Ethnicity

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Abstract

Israel is a small country with a highly diverse population in terms of ethnicity, religion, genetics and lifestyle, which all have an impact on coronary heart disease (CHD) and metabolic risk factors. This review focuses on gender and ethnic group differences in the risk factors associated with CHD. Using the metabolic syndrome (MetSyn) as a guiding theoretical framework, 30 empirical studies from Israel published after the year 2000 were reviewed to elicit trends. Overall, the MetSyn framework appears to be less appropriate for women than for men in predicting CHD morbidity. In addition, ethnic minorities are more likely to have earlier and more severe risk factor profiles, and women are almost always disproportionately affected. Over a period of 5 to 15 years after arrival in Israel, immigrants from the former Soviet Union and Ethiopia show an increase in obesity. Recent intervention studies to reduce CHD risk have shown encouraging results when the programs are culturally tailored.

Keywords

Israel Women Gender differences Coronary artery disease Negev Bedouin Cardiomyopathy Metabolic syndrome Heart failure Cardiac arrhythmias Inflammatory heart disease Type 2 Diabetes Hypertension Dyslipidemia Obesity 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    State of Israel Ministry of Health: Health in Israel, Selected Data Edited by Health Information and Computer Services HID. Jerusalem; 2010.Google Scholar
  2. 2.
    Zhang Y. Cardiovascular diseases in American women. Nutr Metab Cardiovasc Dis. 2010;20:386–93.PubMedCrossRefGoogle Scholar
  3. 3.
    Barrett-Connor E. Commentary: masculinity, femininity and heart disease. Int J Epidemiol. 2007;36:621–2.PubMedCrossRefGoogle Scholar
  4. 4.
    Blum A, Blum N. Coronary artery disease: are men and women created equal? Gend Med. 2009;6:410–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Women's Heart Health Education Initiative: about the initiative. hin.nhlbi.nih.gov/womencvd/whei. Accessed: 10 May 2012.Google Scholar
  6. 6.
    Cwikel JG. A textbook of social epidemiology – strategies for public health activism. New York: Columbia University Press; 2006.Google Scholar
  7. 7.
    Fleury J, Keller C, Murdaugh C. Social and contextual etiology of coronary heart disease in women. J Womens Health Gend Based Med. 2000;9:967–78.PubMedCrossRefGoogle Scholar
  8. 8.
    Ren J, Kelley RO. Cardiac health in women with metabolic syndrome: clinical aspects and pathophysiology. Obesity (Silver Spring). 2009;17:1114–23.Google Scholar
  9. 9.
    Giardina EG, Sciacca RR, Foody JM, D'Onofrio G, Villablanca AC, Leatherwood S, et al. The DHHS Office on Women's Health Initiative to Improve Women's Heart Health: focus on knowledge and awareness among women with cardiometabolic risk factors. J Womens Health (Larchmt). 2011;20:893–900.CrossRefGoogle Scholar
  10. 10.
    Rennert G, Luz N, Tamir A, Peterburg Y. Chronic disease prevalence in immigrants to Israel from the former USSR. J Immigrant Health. 2002;4:29–33.CrossRefGoogle Scholar
  11. 11.
    Salameh S, Hochner-Celnikier D, Chajek-Shaul T, Manor O, Bursztyn M. Ethnic gap in coronary artery disease: comparison of the extent, severity, and risk factors in Arab and Jewish middle-aged women. J Cardiometab Syndr. 2008;3:26–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Kark JD, Fink R, Adler B, Goldberger N, Goldman S. The incidence of coronary heart disease among Palestinians and Israelis in Jerusalem. Int J Epidemiol. 2006;35:448–57.PubMedCrossRefGoogle Scholar
  13. 13.
    Na'amnih W, Muhsen K, Tarabeia J, Saabneh A, Green MS. Trends in the gap in life expectancy between Arabs and Jews in Israel between 1975 and 2004. Int J Epidemiol. 2010;39:1324–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Bilenko N, Shahar D, Shai I, Weitzman S, Fraser D. Prevalence and characteristics of myocardial infarction, diabetes and hypertension in the adult Jewish population: results from the Negev Nutritional Study. Harefuah. 2003;142:17–21, 79.PubMedGoogle Scholar
  15. 15.
    Tekes-Manova D, Israeli E, Shochat T, Swartzon M, Gordon S, Heruti R, et al. The prevalence of reversible cardiovascular risk factors in Israelis aged 25–55 years. Isr Med Assoc J. 2006;8:527–31.PubMedGoogle Scholar
  16. 16.
    Grotto I, Grossman E, Huerta M, Sharabi Y. Prevalence of prehypertension and associated cardiovascular risk profiles among young Israeli adults. Hypertension. 2006;48:254–9.PubMedCrossRefGoogle Scholar
  17. 17.
    • Plakht Y, Gilutz H, Shiyovich A, Zahger D, Weitzman S. Gender and ethnic disparities in outcome following acute myocardial infarction among Bedouins and Jews in southern Israel. Eur J Public Health. 2011;21:74–80. This study looked at both gender and ethnic group differences. PubMedCrossRefGoogle Scholar
  18. 18.
    Gidron Y, Levy A, Cwikel J. Psychosocial and reported inflammatory disease correlates of self-reported heart disease in women from South of Israel. Women Health. 2006;44:25–40.PubMedGoogle Scholar
  19. 19.
    Flatau E, Trougouboff P, Kaufman N, Reichman N, Luboshitzky R. Prevalence of hypothyroidism and diabetes mellitus in elderly kibbutz members. Eur J Epidemiol. 2000;16:43–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Abou-Rbiah Y, Weitzman S. Diabetes among Bedouins in the Negev: the transition from a rare to a highly prevalent condition. Isr Med Assoc J. 2002;4:687–9.PubMedGoogle Scholar
  21. 21.
    Stern E, Raz I, Weitzman S. Prevalence of diabetes mellitus among workers in Israel: a nation-wide study. Acta Diabetol. 1999;36:169–72.PubMedCrossRefGoogle Scholar
  22. 22.
    Haron Y, Hussein O, Epstein L, Eilat D, Harash B, Linn S. Type 2 diabetes among Circassians in Israel. Isr Med Assoc J. 2006;8:622–6.PubMedGoogle Scholar
  23. 23.
    Abdul-Ghani MA, Kher J, Abbas N, Najami T. Association of high body mass index with low age of disease onset among Arab women with type 2 diabetes in a primary care clinic. Isr Med Assoc J. 2005;7:360–3.PubMedGoogle Scholar
  24. 24.
    • Kalter-Leibovici O, Chetrit A, Lubin F, Atamna A, Alpert G, Ziv A, et al. Adult-onset diabetes among Arabs and Jews in Israel: a population-based study. Diabet Med. 2011; doi:10.1111/j.1464-5491.2011.03516.x. A study that differentiates between lifestyle and social status variables in the prevalence of diabetes.
  25. 25.
    Biderman A, Rosenblatt I, Rosen S, Zangwill LM, Shalev R, Friger M, et al. Sex differentials in predictors of mortality for patients with adult-onset diabetes: a population-based follow-up study in Beer-Sheva, Israel. Diabetes Care. 2000;23:602–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Dreiher J, Cohen AD, Weitzman S, Sharf A, Shvartzman P. Lipid levels among African and Middle-Eastern Bedouin populations. Med Sci Monit. 2008;14:CR339–344.PubMedGoogle Scholar
  27. 27.
    Jabara R, Namouz S, Kark JD, Lotan C. Risk characteristics of Arab and Jewish women with coronary heart disease in Jerusalem. Isr Med Assoc J. 2007;9:316–20.PubMedGoogle Scholar
  28. 28.
    Mager A, Koren-Morag N, Shohat M, Dadashev A, Kornowski R, Battler A, et al. Impact of ethnicity and MTHFR genotype on age at onset of coronary artery disease in women in Israel. Isr Med Assoc J. 2008;10:516–9.PubMedGoogle Scholar
  29. 29.
    Kark JD, Goldberger N, Fink R, Adler B, Kuulasmaa K, Goldman S. Myocardial infarction occurrence in Jerusalem: a Mediterranean anomaly. Atherosclerosis. 2005;178:129–38.PubMedCrossRefGoogle Scholar
  30. 30.
    Keinan-Boker L, Noyman N, Chinich A, Green MS, Nitzan-Kaluski D. Overweight and obesity prevalence in Israel: findings of the first national health and nutrition survey (MABAT). Isr Med Assoc J. 2005;7:219–23.PubMedGoogle Scholar
  31. 31.
    Kaluski DN, Berry EM. Prevalence of obesity in Israel. Obes Rev. 2005;6:115–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Kalter-Leibovici O, Atamna A, Lubin F, Alpert G, Keren MG, Murad H, et al. Obesity among Arabs and Jews in Israel: a population-based study. Isr Med Assoc J. 2007;9:525–30.PubMedGoogle Scholar
  33. 33.
    Fraser D, Bilenko N, Vardy H, Abu-Saad K, Shai I, Abu-Shareb H, et al. Differences in food intake and disparity in obesity rates between adult Jews and Bedouins in southern Israel. Ethn Dis. 2008;18:13–8.PubMedGoogle Scholar
  34. 34.
    Regev-Tobias H, Reifen R, Endevelt R, Havkin O, Cohen E, Stern G, et al. Dietary acculturation and increasing rates of obesity in Ethiopian women living in Israel. Nutrition. 2012;28:30–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Greenberg L, Cwikel J, Mirsky J. Cultural correlates of eating attitudes: a comparison between native-born and immigrant university students in Israel. Int J Eat Disord. 2007;40:51–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Shmueli A, Tamir D. Health behavior and religiosity among Israeli Jews. Isr Med Assoc J. 2007;9:703–7.PubMedGoogle Scholar
  37. 37.
    Feinson MC, Meir A. Disordered eating and religious observance: a focus on ultra-Orthodox Jews in an adult community study. Int J Eat Disord. 2012;45:101–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Bilenko N, Fraser D, Vardi H, Shai I, Shahar DR. Mediterranean diet and cardiovascular diseases in an Israeli population. Prev Med. 2005;40:299–305.PubMedCrossRefGoogle Scholar
  39. 39.
    Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229–41.PubMedCrossRefGoogle Scholar
  40. 40.
    Abdul-Ghani MA, Sabbah M, Muati B, Dakwar N, Kashkosh H, Minuchin O, et al. High frequency of pre-diabetes, undiagnosed diabetes and metabolic syndrome among overweight Arabs in Israel. Isr Med Assoc J. 2005;7:143–7.PubMedGoogle Scholar
  41. 41.
    Dankner RS, Chetrit A, Goldbourt U. The metabolic syndrome and glucose tolerance status deterioration over 23-year follow-up. Diabetes Care. 2006;29:1715–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Zornitzki T, Ayzenberg O, Gandelman G, Vered S, Yaskil E, Faraggi D, et al. Diabetes, but not the metabolic syndrome, predicts the severity and extent of coronary artery disease in women. QJM. 2007;100:575–81.PubMedCrossRefGoogle Scholar
  43. 43.
    • Kalter-Leibovici O, Younis-Zeidan N, Atamna A, Lubin F, Alpert G, Chetrit A, et al. Lifestyle intervention in obese Arab women: a randomized controlled trial. Arch Intern Med. 2010;170:970–6. This study is an excellent example of how to tailor CAD risk factor interventions for ethnic group women. PubMedCrossRefGoogle Scholar
  44. 44.
    Stern N, Izkhakov Y. The metabolic syndrome revisited: "cardiometabolic risk" emerges as common ground between differing views of the ADA and AHA. J Cardiometab Syndr. 2006;1:362–3.PubMedCrossRefGoogle Scholar
  45. 45.
    Tenenbaum A, Fisman EZ. "The metabolic syndrome… is dead": these reports are an exaggeration. Cardiovasc Diabetol. 2011;10:11.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Michal Soffer
    • 1
  • Julie Cwikel
    • 1
  • Ilana Harman Boehm
    • 2
  1. 1.The Center for Women’s Health Studies and Promotion and the Spitzer Department of Social WorkBen-Gurion University of the NegevBeer ShevaIsrael
  2. 2.Internal Medicine, Soroka University Medical CenterBen-Gurion University of the NegevBeer ShevaIsrael

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