Atherosclerosis across 4000 years of human history: The Horus study of four ancient populations

Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. Electronic address: .
The Lancet (Impact Factor: 45.22). 03/2013; 381(9873). DOI: 10.1016/S0140-6736(13)60598-X
Source: PubMed


BACKGROUND: Atherosclerosis is thought to be a disease of modern human beings and related to contemporary lifestyles. However, its prevalence before the modern era is unknown. We aimed to evaluate preindustrial populations for atherosclerosis. METHODS: We obtained whole body CT scans of 137 mummies from four different geographical regions or populations spanning more than 4000 years. Individuals from ancient Egypt, ancient Peru, the Ancestral Puebloans of southwest America, and the Unangan of the Aleutian Islands were imaged. Atherosclerosis was regarded as definite if a calcified plaque was seen in the wall of an artery and probable if calcifications were seen along the expected course of an artery. FINDINGS: Probable or definite atherosclerosis was noted in 47 (34%) of 137 mummies and in all four geographical populations: 29 (38%) of 76 ancient Egyptians, 13 (25%) of 51 ancient Peruvians, two (40%) of five Ancestral Puebloans, and three (60%) of five Unangan hunter gatherers (p=NS). Atherosclerosis was present in the aorta in 28 (20%) mummies, iliac or femoral arteries in 25 (18%), popliteal or tibial arteries in 25 (18%), carotid arteries in 17 (12%), and coronary arteries in six (4%). Of the five vascular beds examined, atherosclerosis was present in one to two beds in 34 (25%) mummies, in three to four beds in 11 (8%), and in all five vascular beds in two (1%). Age at time of death was positively correlated with atherosclerosis (mean age at death was 43 [SD 10] years for mummies with atherosclerosis vs 32 [15] years for those without; p<0·0001) and with the number of arterial beds involved (mean age was 32 [SD 15] years for mummies with no atherosclerosis, 42 [10] years for those with atherosclerosis in one or two beds, and 44 [8] years for those with atherosclerosis in three to five beds; p<0·0001). INTERPRETATION: Atherosclerosis was common in four preindustrial populations including preagricultural hunter-gatherers. Although commonly assumed to be a modern disease, the presence of atherosclerosis in premodern human beings raises the possibility of a more basic predisposition to the disease. FUNDING: National Endowment for the Humanities, Paleocardiology Foundation, The National Bank of Egypt, Siemens, and St Luke's Hospital Foundation of Kansas City.

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Available from: Muhammad Al-Tohamy, Jul 19, 2014
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    • "MUMAB: A CONVERSATION WITH THE PAST corresponds well with that of calcified atherosclerotic plaques in other ancient Egyptian mummies (cf. Allam et al., 2009; Thompson et al., 2013 "
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    ABSTRACT: In May of 1994, Drs. Bob Brier and Ronn Wade produced the first modern mummy embalmed in the ancient Egyptian tradition. MUMAB (Mummy, University of Maryland At Baltimore) has been studied over the intervening 18 years as part of the Mummy Replication Project, including high-resolution computed tomography scanning, magnetic resonance imaging, and histological examination. The radiological study of MUMAB is combined here with the firsthand discussion of the processes that resulted in the mummy's radiographic appearance. This allows for a close examination of the assumptions made in the radiological study of ancient Egyptian mummified human remains in a way not possible for the ancient remains themselves. This article is protected by copyright. All rights reserved. © 2015 Wiley Periodicals, Inc.
    Full-text · Article · Mar 2015 · The Anatomical Record
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    • "The basic atherosclerotic mechanisms include altered lipid profile and inflammatory processes [1], [2]. Recently, it has been evidenced that atherosclerosis, surprisingly found in pre-modern human beings, could be due to a basic predisposition rather than to contemporary lifestyles [3]. Mounting evidence continues to support a key role for immune/allergic mechanisms in various phases of atherosclerosis [4], as confirmed by an up-to-date research showing that IgE stimulates human and mouse arterial cell apoptosis as well as cytokine expression, and promotes atherogenesis in ApoE-/- mice [5]. "
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    ABSTRACT: Background Non-Alcoholic Fatty Liver Disease (NAFLD) is a distinct coronary artery disease (CAD) risk factor. The atherosclerotic process predisposing to CAD includes altered lipid profile and inflammatory processes. The available evidence suggests that increased circulating levels of eotaxin, an eosinophil chemoattractant cytokine implicated in allergic responses, are detected in the serum of patients with CAD. Relationships were sought between serum eotaxin on the one hand, and intima-media thickness—an early predictor of the atherosclerotic process, hepatic steatosis, arterial blood pressure values, as well as inflammation/immune markers and angiogenetic factors—on the other. Methods Eighty obese patients with NAFLD, diagnosed at ultrasonography, without evident cytolysis, formed our study population. Anthropometric measures, metabolic profile, serum concentrations of interleukin-1β, C-reactive protein, interleukin-6, fibrinogen, ferritin, TNF-α, spleen size, vascular endothelial growth factor, platelet-derived growth factor-BB and heat shock protein-70 were evaluated. Results Serum eotaxin concentrations were distinctly associated with TNF α, IL-6, IL-1β, VEGF and PDGF-BB levels but not with CRP, fibrinogen, heat shock protein-70 or spleen size. Among the metabolic and anthropometric parameters, a significant predictive power emerged when comparing eotaxin to insulin resistance, expressed as HOMA. NAFLD was distinctly associated with HOMA (P = 0.0005). Intima-media thickness was well predicted by both eotaxin levels and severity of NAFLD at ultrasonography, although no relation was detected between these last two variables. Discussion and Conclusion A role for insulin resistance in mediating the interplay between eotaxin and other inflammation/immune parameters could be evidenced in the induction/maintenance of atherosclerosis of obese patients with NAFLD.
    Full-text · Article · Sep 2014 · PLoS ONE
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    • "Although limited in number, the distinctive findings described in this paper accord with those of other scholars , who described the presence of atherosclerosis in ancient preserved bodies with differing lifestyles and diets (Allam et al., 2009, 2011; Zimmerman, 1993). As previously noted by Thompson et al. (2013), it should be recog- nized that imaging studies do not provide pathoanatomical confirmation of lesions. However, histological investigations often require an autopsy, which irreparably compromises valuable mummy samples (Gaeta et al., 2013). "
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    ABSTRACT: Objective: Through the study of preserved human remains, it is now known that atherosclerosis, commonly thought to be a modern disease, also existed in historic and prehistoric periods. To date, however, little evidence of atherosclerosis has been reported in samples of tissues from spontaneously mummified bodies that are often found in European crypts and churches. Methods: Within the framework of the Lithuanian Mummy Project, whole-body computed tomographic scans of seven spontaneous mummies from a crypt in Vilnius were obtained and assessed for indications of atherosclerosis. Results: Three of the mummies investigated showed clear evidence of atherosclerosis, which was at times quite severe. Atherosclerosis is believed to have been prevalent among affluent members of Lithuanian society, which is corroborated by historical sources. Conclusions: In accordance with recent, significant data, this study further demonstrates the antiquity of this disease. Documentary and ethnographic data suggest that lifestyle may have played a role in the onset of atherosclerosis in these individuals.
    Full-text · Article · Sep 2014 · American Journal of Human Biology
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