Horus: Atherosclerosis prevalent among ancient populations

SAN FRANCISCO — A study of geographically and culturally diverse populations spanning more than 4,000 years suggests atherosclerosis was prevalent in ancient civilizations and may in fact be a natural part of the aging process, according to data from the Horus study.

“In the last century, atherosclerotic vascular disease has replaced infectious disease as the leading cause of death across the developed world. A common assumption is that the rise in levels of atherosclerosis is predominantly lifestyle-related and that if modern humans could emulate pre-industrial or even pre-agricultural lifestyles, that atherosclerosis, or at least its clinical manifestations, would be avoided,” study researcher Randall C. Thompson, MD, of St. Luke’s Mid American Heart Institute in Kansas City, Mo., said in a press release.

Randall C. Thompson

“Our findings seem to cast doubt on that assumption, and at the very least, we think they suggest that our understanding of the causes of atherosclerosis is incomplete, and that it might be somehow inherent to the process of human aging,” said Thompson, who presented the data at the American College of Cardiology Scientific Sessions.

Atherosclerosis in ancient times

Thompson and colleagues performed whole-body CT scans on 137 mummies from ancient Egypt (n=76), Peru (n=51), the Ancestral Puebloans of southwest America (n=5) and the Unangan hunter-gatherers from the Aleutian Islands in Alaska (n=5). They defined atherosclerosis as definite if calcified plaque was observed in the artery wall and as probable if calcifications were observed along the expected course of an artery.

The researchers found probable or definite atherosclerosis in 34% of the mummies, including 38% of the Egyptians, 25% of the ancient Peruvians, 40% of the Ancestral Puebloans and 60% of the Unangan hunter-gatherers. Twenty percent had evidence of atherosclerosis in the aorta, 18% in the iliac or femoral arteries, 18% in the popliteal or tibial arteries, 12% in the carotid arteries and 4% in the coronary arteries, according to the study results, which were simultaneously published in The Lancet.

Data also indicated the presence of atherosclerosis in one to two of five vascular beds examined in 25% of the mummies, three to four beds in 8% and all five beds in 1%. Mean age at death was 43 years for mummies with atherosclerosis vs. 32 years for those without (P<.0001), suggesting a positive correlation between age and development of the disease. Similarly, mean age of those with presence of atherosclerosis in one to two arterial beds was 42 years vs. 44 years for those with atherosclerosis affecting three to five beds (P<.0001), the researchers reported.

“It is surprising that atherosclerosis is so very easy to find in these ancient cultures across the globe over a very wide time span and among people with very different genetics, lifestyles and diets,” Thompson said. “One implication is that this disease that we think of in terms of modern lifestyles and diet is actually related to aging. Or perhaps we don’t understand the risk factors as well as we think we do.”

Looking ahead

In an accompanying editorial, Anthony M. Heagerty, MBBS, MD, FRCP, FAHA, FMedSci, of the University of Manchester in the United Kingdom, noted that infection is likely responsible for the development of atherosclerosis in these ancient populations.

“A wealth of evidence points to a key role for inflammation in both circulatory and malignant processes,” he wrote. “High levels of chronic infection and inflammation could have promoted cardiovascular lesion development and, although not being fatal for most, might have become so with the passage of time.”

The lesson, however, is that prevention remains key.

“These data confirm that atheroma has been a burden on the human circulation for centuries. Few are exempt, and as life expectancy lengthens owing to modern advances in public health and medicine, more will suffer its consequences unless urgent measures are taken to prevent its legacy,” he wrote.

For more information:

Heagerty AM. Lancet. 2013;doi:10/1016/S0140-6736(13)60639-X.

Thompson RC. Lancet. 2013;doi:10.1016/S0140-6736(13)60598-X.

Thompson RC. Featured clinical research II: General cardiology. Presented at: American College of Cardiology Scientific Sessions; March 9-12, 2013; San Francisco.

Disclosure: The researchers report no relevant financial disclosures. Heagerty has consulted for and received fees for speaking from Servier, Merck Serono, Novartis and Daiichi-Sankyo.