Take-aways Atherosclerosis is commonly considered a disease of modern times and related to modern lifestyles. The Horus study suggests that atherosclerosis was common in four preindustrial populations, including a pre-agricultural hunter-gather population, and across a wide span of human history. 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.

Atherosclerosis is often considered a hazard of modern life, leading us to yearn for the simpler, healthier lifestyles of old. However, evidence suggests we may be idealizing the past, at least insofar as it applies to ancient civilizations; data suggest life back then wasn't quite the idyllic setting for CV health we assumed it to be.

The Horus study started when cardiologists toured the Egyptian National Museum of Antiquities in Cairo during a medical conference in 2008; they noticed the nameplate of the Pharoah Merenptah, who ruled from 1213-1203 BC. The biographical information noted that Merenptah died at roughly age 60 of atherosclerosis. That seemed like a surprising diagnosis for a time thought to be much less likely to produce atherosclerosis.

35 Centuries Later

Working closely with the museum, an international team of researchers performed whole-body, multislice computed tomography (CT) scanning on 52 ancient Egyptian mummies from the Middle Kingdom to the Greco-Roman period, a timespan of more than 2,200 years.^1,2 The investigators sought to identify CV structures and arterial calcifications.

Images were interpreted by consensus reading of seven imaging physicians and demographic data were determined from historical and museum records. Age at the time of death was estimated from the CT skeletal evaluation.

Of the mummies examined, 44 had identifiable vascular tissue. It was not possible to image all vascular beds in each mummy due to incomplete preservation and variable embalming techniques that differed in terms of the removal of vessels or organs. The aorta, iliac, and peripheral arteries were generally better preserved and available than the coronaries and carotids.

Overall, 45% of the mummies with identifiable CV structures showed vascular calcification. Given that the examination was being performed up to 35 centuries after the subjects had died, it was remarkable that 20 of these mummies had either definite atherosclerosis (defined as calcification within the wall of an identifiable artery; n = 12) or probable atherosclerosis (defined as calcifications along the expected course of an artery; n = 8). The mummies with definite or probable atherosclerosis were about 11 years older at the time of death than the mummies with CV tissue but no atherosclerosis (mean age 45.1 vs. 34.5; p < 0.002).

Thus, vascular calcification affected arteries in many regions of the body in ancient Egyptians, just as it does in contemporary humans.

Worldwide Mummies

Now the Horus study has expanded, obtaining whole body CT scans of 138 mummies from four populations spanning a 3,800-year time horizon, from multiple locations in ancient Egypt, Peru, and North America (the southwestern United States and the Aleutian Islands).³

Thus, the populations studied represented a diverse set of lifestyles, diets, and genetics across a wide geographical range. The ancient Egyptians and Peruvians were farmers with domesticated animals, the Ancestral Puebloans (from Utah) were forager-farmers, and the Unangans (from 500 miles off the Alaskan mainland) were hunter-gatherers without agriculture. The Peruvians and Ancestral Puebloans predated the written word and were thus prehistoric cultures. None of the cultures, however, were known to be vegetarian. Physical activity was probably prominent in all these of civilizations without animal or vehicle transport.

The diets of these peoples were quite disparate, as were the climates. Indigenous food plants varied greatly over the wide geographical distance between these regions of the world. Fish and game were present in all of the cultures, but protein sources varied from domesticated cattle among the Egyptians to an almost entirely marine diet among the Unangans. Mummified Egyptians were generally of higher social status, which may suggest more varied protein and a higher fat diet.

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 and with the number of arterial beds involved.

The findings greatly increase the number of ancient people known to have atherosclerosis and show for the first time that the disease was common in several ancient cultures with varying lifestyles, diets, and genetics, across a wide geographical distance, and over a very long span of human history. The authors state that the study results suggest that our understanding of the causative factors of atherosclerosis is incomplete, and that atherosclerosis could be inherent to the process of human aging.

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References

1. Allam AH, Thompson RC, Wann LS, et al. JACC Cardiovasc Imaging. 2011;4:315-27. http://imaging.onlinejacc.org/cgi/content/abstract/jaccimg;4/4/315
2. Chandrashekhar Y, Narula J. JACC Cardiovasc Imaging. 2011;4:440-3. http://imaging.onlinejacc.org/cgi/content/full/4/4/440
3. Thompson RC, Allam AH, Lombardi GP, et al. Lancet. 2013;381:1211-22.

To listen to an interview with Randall C. Thompson, MD, about findings from the Horus Study, visit youtube.cswnews.org . The interview was conducted by A. John Camm, MD.

Keywords: Atherosclerosis, Culture, Civilization, Vascular Calcification, Multidetector Computed Tomography, Femoral Artery, Mummies, Carotid Arteries, Diet, Tibial Arteries, Consensus

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