Atherosclerosis Across 4000 Years of Human History: The Horus Study of Four Ancient Populations

Study Questions:

Atherosclerosis is thought to be a disease of modern human beings and related to contemporary lifestyles. Is there evidence of atherosclerosis in preindustrial populations?

Methods:

Whole-body computed tomography (CT) scans were obtained in 137 mummies from four different geographical regions or populations spanning more than 4,000 years. 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.

Results:

Periods ranged from 1500 BCE (before common era) to 1500 CE (common era) in all but five mummies in modern-day Alaska (ca 1756-1930 CE). 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 = nonsignificant). 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 1-2 beds in 34 (25%) mummies, in 3-4 beds in 11 (8%), and in all five vascular beds in two (1%). Age at time of death was positively correlated with atherosclerosis (mean [standard deviation] age at death was 43 [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 [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 3-5 beds; p < 0.0001).

Conclusions:

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 humans raises the possibility of a more basic predisposition to the disease.

Perspective:

Interestingly, the findings of coronary calcium by CT in the mummies correlate fairly well with autopsy study results in the past 70 years. By the age of 50 years, atherosclerosis as defined by calcified plaque was present in all five beds in 82% of men and 68% of women, and ubiquitous in men by age 60 and women by age 70 years. In the MESA study, men and women >65 years had abdominal aortic calcification frequency ranging from 80% to 97%, with highest in non-Hispanic whites and lowest in African Americans. And in the PDAY autopsy study of adolescents 15-19 years, all had aortic and approximately 50% had coronary atherosclerosis. The findings do not threaten the evidence that atherosclerotic disease is caused by a gene-environmental interaction that is associated with classic risk factors.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Genetic Arrhythmic Conditions, Computed Tomography, Nuclear Imaging

Keywords: Coronary Artery Disease, Atherosclerosis, Plaque, Atherosclerotic, Tomography, X-Ray Computed, Genetics, Population, European Continental Ancestry Group, Calcinosis, Risk Factors, Hispanic Americans, Autopsy, Pyrrolidinones, Population, Mummies, Genotype


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