Atherosclerotic Mummies

Atherosclerosis, the build up of plaque in an artery, such as a heart artery, is derived from the Greek αθηρα (athera) or “gruel” and σκληρωσις (sclerosis) which means “hardening”. Plaque build up occurs in areas of damage to the inner lining of the wall of the artery and consists of cholesterol, inflammatory cells, platelets and various proteins secreted by the damaged cell wall.  Atherosclerosis is the major killer in the Western world as it may lead to heart attacks, strokes and peripheral artery disease (blockage in a leg artery). Many risk factors have been identified for atherosclerosis including male sex, obesity, sedentary lifestyle, diabetes, high blood pressure, high cholesterol and inflammation.  Genetic factors for atherosclerosis have also been discovered, as the disease tends to run in families.  Atherosclerosis is generally thought of as a disease of modern man, affecting those at an older age and associated with a traditional Western diet and lifestyle. Is this true?

One of the best ways to assess atherosclerosis is imaging with a CT scan.  Plaque occurs in various stages. Early in the disease process, plaque is “soft”, filled with cholesterol. Later on, “hard” plaques develop a thick fibrous cap over the soft core. Calcium is deposited in hard plaque as well, contributing to the “hardness” and the sclerosis in atherosclerosis. The CT scan detects the calcium in the plaque of atherosclerotic arteries. To answer whether atherosclerosis is a modern disease or not, researchers performed CT scans on ancient Egyptian mummies. They found that 20 of the 44 mummies studied had significant atherosclerosis, with calcified plaque identified mostly in the aorta and the leg arteries.  These mummies represented the top tier of ancient Egyptian society, so perhaps their lifestyle and diet was more in line with modern ones. The researchers then expanded their study and performed CT scans on mummies from Peru, southwestern US and the Aleutian Islands.  These mummies represented a range of lifestyles, from rich to poor and from farmers to hunter-gatherers.  Still, significant atherosclerosis was found in 25% of these mummies. Therefore, atherosclerosis was present in ancient civilizations, across differing populations with differing diets and lifestyles.

At what age does atherosclerosis start? To answer the question, researchers looked at autopsy data from people who did not have heart disease and who died from trauma or other causes. The 24,000 autopsies included soldiers who died in battle during the Korean or Vietnam wars. Asymptomatic atherosclerosis was found in 2% of men aged 30 to 39 years old, 5% of men aged 40-49 years old and up to 12% in men 60 to 65 years old. The data for women was lower at each age group, but women tended to catch up to men in their late 50’s and 60’s.  The majority of these autopsies were from the 1950’s and 1960’s, before risk factors for atherosclerosis were identified. Does more updated information confirm this? An autopsy study of victims of sudden cardiac death in children and young adults was performed from 2010 to 2012.  The researchers attributed 118 cases to atherosclerosis and heart artery disease.  In the 20 to 30 year old age group, 36 deaths were from heart artery disease and in the 30 to 35 year olds there were 79 deaths due to heart artery disease.

Atherosclerosis has been with us since ancient times and occurs across a wide variety of human populations with various diets, lifestyles and genetics.  The atherosclerotic plaque develops at a young age, likely in our teens and twenties, and can progress over decades if left unchecked until it produces symptoms, a heart attack or a stroke. Therefore, it is never too early to identify and reverse known risk factors: reduce blood pressure, decrease cholesterol, treat diabetes, control obesity and become physically active.