Cardiovascular Morbidity and Risk Factors in Holocaust Survivors in Israel
Omri Zamstein1, Aya Biderman2, Michael Sherf2,3
1Goldman School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Insights
Holocaust survivors exhibit higher rates of cardiovascular diseases and risk factors, including diabetes and hypertension, compared to non-survivors. These health disparities were more pronounced in women, highlighting long-term health impacts.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The long-term health consequences of extreme stress, such as that experienced during the Holocaust, are a significant public health concern.
- Cardiovascular diseases (CVD) and their risk factors represent a major global health burden.
Purpose of the Study:
- To investigate the prevalence of cardiovascular diseases and associated risk factors among Holocaust survivors.
- To compare these health outcomes with a cohort of Jewish immigrants not exposed to Nazi occupation.
Main Methods:
- A population-based, cross-sectional study was conducted using data from Clalit, an Israeli healthcare provider.
- Holocaust survivors (n=83,971) were compared to a matched group (n=16,058) of Jewish immigrants using propensity score matching.
- Univariate and multivariable logistic regression analyses were performed to assess CVD and risk factor prevalence.
Main Results:
- Holocaust survivors showed significantly higher prevalence of ischemic heart disease, congestive heart failure, past stroke, and peripheral vascular disease.
- Elevated rates of diabetes mellitus, hypertension, and dyslipidemia were also observed in Holocaust survivors.
- Multivariable analysis indicated increased odds for most cardiovascular diseases and risk factors in survivors, particularly women.
Conclusions:
- The prevalence of cardiovascular diseases and risk factors is higher among Holocaust survivors.
- These associations are stronger in women, suggesting sex-specific long-term health impacts of trauma.
- Findings underscore the enduring health burden of Holocaust survival and inform targeted public health interventions.
Objectives:
To compare the prevalence of cardiovascular diseases and risk factors in Holocaust survivors with that of Jewish immigrants from Europe and America.
Design:
Population-based, cross-sectional study.
Setting:
Clalit, a large Israeli healthcare provider.
Participants:
Holocaust survivors (n=83,971) and a comparison group of Jewish individuals born in North or South America or European countries not under Nazi occupation or who immigrated to Israel before 1939 (n=16,058) (mean age 84±7, 61% female) MEASUREMENTS: Univariate and multivariable logistic regression analyses of cardiovascular diseases and risk factors. Matching the comparison group to Holocaust Survivors on propensity scores for exposure.
Results:
The prevalence of ischemic heart disease (38.7% vs 31.3%), congestive heart failure (10.9% vs 9.1%), past stroke (15.7% vs 13.4%), and peripheral vascular disease (9.5% vs 7.9%) was higher in Holocaust survivors (p<.001 for all comparisons). Similar results were found for cardiovascular risk factors (diabetes mellitus (14.4% vs 13.6%), hypertension (89.3% vs 86.4%), dyslipidemia (75.9% vs 74.0%) (p<.001 for all comparisons). In multivariable analysis, matched on propensity scores and controlled for confounders, odds ratios for men and women were higher for diabetes (1.23, 1.55), dyslipidemia (1.53, 1.51), hypertension (1.56 , 1.94), stroke (1.18, 1.17), and ischemic heart disease (1.18, 1,40), but not congestive heart failure (0.95, 1.02). A Positive association was noted for peripheral vascular disease in males (1.20) but not females (0.96).
Conclusion:
Prevalence of cardiovascular diseases and risk factors was higher in Holocaust survivors. These associations were stronger in women in most cases.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:12Relative Risk
01:14Overview of the Cardiovascular System
Heart
The heart is the central pump of the cardiovascular system that circulates blood throughout the body. It comprises two atria receiving the blood and two ventricles pumping blood out of the heart. Their rhythmic contractions, called heartbeats, ensure that blood flow remains continuous.
Blood Vessels
Blood...
01:27Regulation of the Cardiovascular System
The regulation of the cardiovascular system involves the autonomic nervous system (ANS), baroreceptors, and chemoreceptors, ensuring that heart rate and blood pressure are appropriately modulated in response to varying physiological demands.
The ANS comprises two main divisions: the sympathetic and parasympathetic nervous systems. The sympathetic nervous system enhances...
02:16Transcription Factors
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...