Researchers: Half of Israelis will need cardiac treatment

The Israeli association of atherosclerosis specialists, which has recently released new guidelines on heart attack prevention, recommend lowering "bad" cholesterol by significantly increasing treatment using the popular Statin-group medications.

The Society for Research, Prevention and Treatment of Atherosclerosis expects its guidelines will lead to about half of all Israelis over the age of 40 being treated with Statins.

Also among the guidelines, soon to become an official document of the Israel Medical Association, is a fish-rich Mediterranean diet.

According to the guidelines, Israelis who already suffer from heart disease, diabetes or are in a high risk group for heart attack should maintain a low level of bad cholesterol (known medically as LDL) of 80 milligrams per deciliter of blood, as opposed to the previously recommended level of 100 milligrams per deciliter. Israelis at high risk for heart attack include those suffering from high blood pressure and smokers, among other groups.

According to the directives, people in these groups should begin treatment with Statins, which lower the level of cholesterol in the liver. If this does not lower the LDL sufficiently, the guidelines suggest other medications, such as Ezetrol, which reduces the absorption of cholesterol in the intestine.

"Anyone who has had a heart attack runs five times as high a risk of having another heart attack. The lower the bad cholesterol is, the better the patient's chances of avoiding another heart attack. People released from the hospital after a heart attack should be given a prescription for a Statin," says Professor Hila Knobler, the secretary of the Society for Research, Prevention and Treatment of Atherosclerosis.

The association's guidelines recommend that healthy people and smokers who have no medical complications bring their cholesterol level to below 130 milligrams per deciliter. "First cholesterol should be lowered by proper nutrition and physical activity, and if that doesn't help, drugs are recommended," Knobler says.

"A change in cholesterol levels being advised for high-risk patients is significant news," the chairwoman of the association, Professor Tova Chajek-Shaul, says. "If these patients maintain the new target levels, we can prevent many heart attacks and strokes. We are transmitting a message not only to patients, but also to health maintenance organizations, to allow people in high-risk groups to receive medication so they can reach these target levels." Maintaining low cholesterol levels can save thousands of lives a year, Chajek-Shaul adds.

New Med diet

The new Israeli guidelines have adopted recommendations published by the European Society of Cardiology in 2007. The formulation of new guidelines is also underway in the United States, which are expected to be published in 2010.

In addition to becoming an official document of the Israel Medical Association, negotiations are to begin between various medical associations and the management of HMOs to adopt the guidelines and turn them into a regular protocol.

The last guidelines were published in 2005, and they are not legally binding. However, courts have ruled in the past against physicians who departed from recommended Israel Medical Association guidelines in treating patients. Support for the latest guidelines has come from a number of medical associations.

The new guidelines to lower cholesterol replace the classic low-fat diet recommended to overweight Israelis with a new Mediterranean diet containing a large percentage of fats from fish, poultry, olive oil and nuts, and high vegetable consumption, while limiting consumption of red meat.

"Recent studies show that long-term maintainence of such a diet reduces illness and death from heart and vascular disease," Knobler says.

The latest guidelines suggest limiting the intake of red meat to two lean servings per week, and to avoid the trans fats in pastries such as bourekas. Healthy people can eat five eggs a week, according to the guidelines.

It is recommended that all Israelis, both healthy and sick, exercise five times a week. Before embarking on an exercise program, men over 45 and women over 55 should undergo a stress test, the guidelines say.