The Israeli death rate from heart disease has plunged by an impressive 50 percent since 1998, according to a study just published in the European Heart Journal.Emeritus Prof. Mervyn Gotsman, who was for many years head of Hadassah-University Medical Center’s cardiology department and personal physician of prime minister Menachem Begin, wrote it along with his son, who currently works in the same department.The major drop in annual cardiac mortality from 160 per 100,000 Israelis to just 80 is “one of the most dynamic phenomena in Israeli medicine,” they wrote.Among the reasons they gave were the decline in smoking, vigorous primary and secondary prevention of atherosclerosis, national campaigns against obesity, diabetes and hypertension and for modification of lifestyles, the liberal use of statins to lower LDL (“bad”) cholesterol levels and well as the very early management of acute myocardial infarction, including by angioplasty. They credited the Israel Heart Society and the Health Ministry for much of these preventive measures.Other factors involved include the extensive use of emergency ambulance services throughout the country, including in the periphery, specialized intensive care units in all the regional hospitals under the care of experienced cardiologists, the use of more effective anticoagulants to dissolve blood clots, the careful management of cardiogenic shock and the insertion of improved stents to keep open coronary arteries, interventional procedures for arrhythmias (irregular heartbeat) and interventional procedures of treating diseased heart valves.Limited numbers of heart transplants and left-ventricular assist devices are also available for suitable candidates, said the Gotsmans. “No less important is the aggressive management of peripheral arterial disease and strokes. Population-wide educational programs have been essential. The mortality curve continues to fall.”The authors added that this excellent outcome may also be a consequence of universal availability of affordable health funds for the entire population, irrespective of race, color and creed. “It is also a response to the enthusiasm of Israeli cardiologists, physicians, general practitioners, nurses and technicians to prolong life, alleviate suffering, and improve the quality of life.”There is still more to be done and the trajectory should continue to plummet, they wrote.For example, “we need a simple genetic map to identify healthy patients at risk from sudden death, arrhythmias and coronary artery and other vascular diseases. We need to recognize all the “vulnerable patients who need lifestyle modification and the management of risk factors, particularly smoking, the metabolic syndrome, diabetes, and obesity.All patients at risk from sudden primary ventricular fibrillation need electronic monitoring, GPS coverage and a national monitoring system which will identify potential malignant arrhythmias and by using telephone communication and an ambulance or motorcycle dispatch service to provide immediate on-site care.“Universal rehabilitation is essential for all patients who have suffered a heart attack... Stroke management needs nationwide revitalization with primary prevention and immediate invasive therapy to be available in every hospital,” they wrote.“This 50 percent reduction in mortality of cardiovascular disease in Israel is an example of the efforts of a small country with a heterogeneous population” of nearly 8 million inhabitants, and should serve as a trajectory of improvement for our other European and international colleagues, the Gotsmans wrote.