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

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.

[1]  W. Dall.  On the remains of later prehistoric man obtained from caves in the Catherina Archipelago, Alaska Territory, and especially from the caves of the Aleutian Islands. By W.H. Dall. , 2022 .

[2]  Randall C. Thompson,et al.  Computed tomographic assessment of atherosclerosis in ancient Egyptian mummies. , 2009, JAMA.

[3]  Caleb E. Finch,et al.  Evolution of the human lifespan and diseases of aging: Roles of infection, inflammation, and nutrition , 2009, Proceedings of the National Academy of Sciences.

[4]  A. Heagerty,et al.  Atherosclerosis and diet in ancient Egypt , 2010, The Lancet.

[5]  A. Hrdlička.  The Aleutian and Commander islands and their inhabitants , 1945 .

[6]  M. LeMay,et al.  The paleopathology of an Aleutian mummy. , 1981, Archives of pathology & laboratory medicine.

[7]  M. Zimmerman,et al.  Examination of an Aleutian mummy. , 1971, Bulletin of the New York Academy of Medicine.

[8]  J F Cornhill,et al.  Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. , 1999, JAMA.

[9]  J. Weyer.  Review: the Aleutian and Commander Islands and Their Inhabitants, By Ales Hrdlicka [Wistar Institute of Anatomy and Biology. Philadelphia, 1945] , 1945 .

[10]  D. Ubelaker,et al.  Standards for Data Collection from Human Skeletal Remains , 1994 .

[11]  E. Steinhagen-Thiessen,et al.  A Systematic Literature Review of the Association of Lipoprotein(a) and Autoimmune Diseases and Atherosclerosis , 2012, International journal of rheumatology.

[12]  M. Zimmerman.  The paleopathology of the cardiovascular system. , 1993, Texas Heart Institute journal.

[13]  Vernon L. Scarborough,et al.  Hisat’sinom: Ancient Peoples in a Land without Water , 2014 .

[14]  W. Laughlin.  Aleuts: Survivors of the Bering Land Bridge , 1981 .

[15]  C. Lovejoy,et al.  Radiographic changes in the clavicle and proximal femur and their use in the determination of skeletal age at death. , 1985, American journal of physical anthropology.

[16]  Horst Seidler,et al.  The iceman: discovery and imaging. , 2003, Radiology.

[17]  Randall C. Thompson,et al.  Atherosclerosis in ancient Egyptian mummies: the Horus study. , 2011, JACC. Cardiovascular imaging.

[18]  J. Vaupel,et al.  Broken Limits to Life Expectancy , 2002, Science.

[19]  M. Criqui,et al.  Patterns and Risk Factors for Systemic Calcified Atherosclerosis , 2004, Arteriosclerosis, thrombosis, and vascular biology.

[20]  D. Mininberg.  The Museum’s Mummies: An Inside View , 2001, Neurosurgery.

[21]  L. Gavrilov,et al.  :The Biology of Human Longevity: Inflammation, Nutrition, and Aging in the Evolution of Lifespans , 2008 .

[22]  M. Ruffer.  On arterial lesions found in Egyptian mummies (1580 B.C.—525 A.D.) , 1911 .

[23]  R. Kronmal,et al.  Ethnic-specific risks for atherosclerotic calcification of the thoracic and abdominal aorta (from the Multi-Ethnic Study of Atherosclerosis). , 2009, The American journal of cardiology.

[24]  W D Wagner,et al.  A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. , 1995, Arteriosclerosis, thrombosis, and vascular biology.

[25]  J. Steinbring.  Review: Aleuts: Survivors of the Bering Land Bridge, By William S. Laughlin. Holt, Rinehart, and Winston, New York, 1980 , 1983 .

[26]  J. O’Keefe,et al.  Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome: how to become a 21st-century hunter-gatherer. , 2004, Mayo Clinic proceedings.

[27]  W. Darby,et al.  Food: the gift of Osiris , 1978, Medical History.