CAD Is Disease of the Ancients
Published: Mar 10, 2013

By Kristina Fiore , Staff Writer, MedPage Today

Full Story:  http://www.medpagetoday.com/MeetingCoverage/ACC/37790

SAN FRANCISCO — Atherosclerosis was a plague among ancient peoples, even hunter-gatherers who were perceived to have a good diet and get plenty of exercise, researchers reported here.

Heart and vascular calcifications were spotted on CT scans of mummies from four different ancient cultures including Egyptian, Peruvian, Ancestral Puebloan, and Unangan, according to Randall Thompson, MD, of St. Luke’s Mid America Heart Institute in Kansas City, Mo., and colleagues.

They reported their findings online in The Lancet and at the American College of Cardiology meeting here.

“Although commonly assumed to be a modern disease, the presence of atherosclerosis in pre-modern humans raises the possibility of a more basic predisposition to the disease,” they wrote.

Robert Califf, MD, of Duke University Medical Center, who was not involved in the study, told MedPage Today that clogged arteries indeed appear to be a phenomenon of aging as well as lifestyle.

“The fundamental findings that there is atherosclerosis, but not a huge amount, raises the intriguing possibility this is not just a modern phenomenon, it’s probably a part of human history.”

Atherosclerosis has been perceived as a modern disease because of its associations with sedentary lifestyles and poor diets of many present-day cultures. It has also been assumed that if modern humans could mimic the diet and lifestyle habits of pre-industrial or even pre-agricultural people, atherosclerosis could be avoided.

But the mummy literature has been painting a different picture. Researchers found calcification in the arteries of the “Iceman” from 3,000 BCE who was discovered in present-day Italy.

And Thompson and colleagues have previously found evidence of atherosclerosis on CT scans of Egyptian mummies hailing from various dynasties.

To rule out the role that factors such as culture and lifestyle may play on the formation of atherosclerosis specifically in Egyptians, Thompson and colleagues decided to widen their CT studies to other ancient peoples with different lifestyles, diets, and genetic features.

In the HORUS study, named for an ancient Egyptian deity, they conducted whole-body CT scans of 137 mummies from four geographic regions or populations spanning more than 4,000 years: ancient Egypt, ancient Peru, the Ancestral Puebloans of southwest America, and the Unangan of the Aleutian Islands in present-day Alaska.

They had a panel of seven experienced cardiovascular imaging physicians determine either the “probable” or “definite” presence of atherosclerosis.

Overall, they found probable or definite atherosclerosis in 34% of the mummies in all four populations (25 had definite and 22 had probable disease):

• 29 of 76 of the Egyptians (38%)
• 13 of 51 of the Peruvians (25%)
• 2 of 5 of the Ancestral Puebloans (40%)
• 3 of 5 of the Unangan hunter gatherers (60%)

Atherosclerosis was present in the aorta in 20% of mummies, iliac or femoral arteries in 18%, popliteal or tibial arteries in 18%, carotid arteries in 12%, and coronary arteries in 4%.

Looking at five different vascular beds, they found atherosclerosis in one to two beds in 25% of mummies, in three to four beds in 8%, and in all five beds in only 1%.

Those with atherosclerosis were about a decade older at the time of death — 43 versus 32 (P<0.0001).

They also found in a logistic regression model that the odds of increasing atherosclerosis severity rose by about 69% per each decade of life (OR 1.69, 95% CI 1.19 to 2.40).

But there were no significant associations by sex or by the historical time period, they reported.

Reasons for the presence of atherosclerosis across all four populations remain unclear. The groups shared many common dietary elements, none were vegetarian, and it was expected that they all had a decent amount of daily activity.

One common element, however, was cooking.

“Although cigarette smoking was not part of these four ancient populations, the need for fire and thus smoke inhalation could have played a part in the development of atherosclerosis,” Thompson and colleagues wrote.

Califf postulated that the mechanism may be a regenerative one that may begin to wear out as patients age: “That could happen because you get old, or it can happen at a younger age because you smoke cigarettes or eat a high-fat diet.

They cautioned that the study used calcification as a marker of atherosclerosis and couldn’t attain pathological confirmation that calcifications represent atherosclerosis. But they noted that calcifications on imaging studies in current patients are deemed characteristic for clinical atherosclerosis.

They also warned that the small sample size lacks the statistical power to detect differences in the incidence and severity of atherosclerosis across cultures.

Still, they concluded that the “presence of atherosclerosis in pre-modern human beings suggests that the disease is an inherent component of human aging and not associated with any specific diet or lifestyle.”

The study was supported by the National Endowment for the Humanities, Paleocardiology Foundation, the National Bank of Egypt, Siemens, and St. Luke’s Hospital Foundation of Kansas City.

The researchers reported no conflicts of interest.

Primary source: The Lancet
Source reference: Thompson RC, et al “Atherosclerosis across 4,000 years of human history: The Horus study of four ancient populations” Lancet 2013; DOI: S0140-6736(13)60598-X.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60598-X/fulltext