Earliest case of heart disease in ancient Egyptian mummies recorded

KANSAS CITY, Mo. (April 4, 2011) — A study supported by the Saint Luke’s Hospital Foundation and conducted by a U.S.-Egyptian research team has uncovered the earliest documented case of coronary atherosclerosis – a build-up of plaque in the arteries that supply the heart muscle that can result in heart attack – in a princess who died in her early 40’s and lived between 1580 and 1550 B.C.

Of the other mummies studied – a sampling of the elite in ancient Egypt – almost half showed evidence of atherosclerosis in one or more of their arteries, calling into question the researcher’s perception of atherosclerosis as a modern disease.

The study was presented April 3 at the American College of Cardiology’s 60th annual scientific session in New Orleans and is appearing simultaneously on-line and in print in The Journal of the American College of Cardiology: Cardiovascular Imaging.

New data indicates heart disease was prevalent in ancient Egypt

Saint Luke’s cardiologist Randall Thompson, M.D., is an expert in cardiovascular Computed Tomography (CT) imaging and one of the key investigators in the study. While previously published research revealed atherosclerosis in ancient Egyptians, this latest study brings new findings to light. The study for the first time documented ancient disease in the carotid and coronary arteries, the vessels responsible for heart attacks and strokes. In addition to documenting the earliest case ever found, this study found it to be more prevalent than initially thought, said Dr. Thompson.

The interdisciplinary team performed whole body computerized tomography (CT) scans on 52 ancient Egyptian mummies to determine if atherosclerosis was present. Of the 44 with identifiable arteries or hearts, nearly half (45 percent) had calcifications either in the wall of an artery or along the course of an artery that are diagnostic of or highly suggestive of atherosclerosis.

“While we usually think of atherosclerosis, the disease that causes heart attacks and strokes, as a modern condition and related to our modern lifestyles, these data show evidence that it existed and was not uncommon in ancient times,” said Dr. Thompson. “These results suggest a missing link in our understanding of heart disease, and that we may need to look beyond the traditional risk factors.”

Most of the atherosclerosis was found in the large arteries of the body, including the aorta in the abdomen. However, key smaller arteries were also involved. About seven percent of the mummies had obstructions in the heart arteries, and 14 percent had blockages in the arteries to the brain (the carotid arteries) - a leading cause of stroke in the present day.

Researchers also found that, similar to now, advancing age was highly predictive of the presence and severity of atherosclerosis. Dr. Thompson, who is also Professor of Medicine at the University of Missouri – Kansas City, explains that the calcific atherosclerosis seen with CT scanning looks almost exactly like the atherosclerosis seen in modern patients and was found in the same locations. While the team could not determine the exact cause of death in these ancient Egyptians, several of the mummies had widespread advanced atherosclerosis and thus, symptomatic disease seems to have been likely.

In order to understand the lifestyles of ancient Egypt’s elite, the team of researchers worked with Egyptologists to review risk factors that might affect the health of the heart and arteries.

“The estimated average age at the time of death of these mummies was around 40 years, and yet atherosclerosis appears to have been common, and in some individual cases, quite advanced. The elite in ancient Egypt certainly ate a richer diet and were less physically active than common laborers from those times, but they probably ate less meat and fat than we do today,” said Dr. Thompson. “We also know that Egyptians did not smoke cigarettes, did not eat trans fats and were more active than we are — yet they still have the same disease that causes heart attacks and strokes. These findings make it clear that we don’t understand atherosclerosis and heart disease as well as we think we do.”

Although it requires further study, the investigators believe these data suggest that genetic factors resulting in atherosclerosis are more important than previously thought. They caution, however, that the genetic factors that may predispose us to the disease are even more compelling reasons to carefully manage risk factors that we have some control over, if not to prevent atherosclerosis, to minimize its impact.

“Abundant research shows that avoidance of cigarette smoking and maintaining a low blood pressure and cholesterol level can delay heart attacks,” said Dr. Thompson. “However, our study indicates that humans are predisposed to atherosclerosis, so it is all the more important to control the risk factors we can in order to delay the disease as long as we can.”

Study co-investigators include Drs. Gregory Thomas, clinical professor and director of Nuclear Cardiology Education, University of California, Irvine; Adel Allam of Al Azhar University, Cairo, Egypt; Samuel Wann of the Wisconsin Heart Hospital, Milwaukee, Wis.; and Michael I. Miyamoto of the Mission Internal Medical Group, Mission Viejo, Calif.

Last year, Dr. Thompson and the research team used their experience in mummy CT scans to collaborate with scholars at the Nelson-Atkins Museum of Art in Kansas City, Mo., and special agents from the bureau of Alcohol, Tobacco and Firearms. That collaboration explored the heath problems that Ka-i-nefer, the mummy in the Nelson-Atkins collection, had had in life, and produced a computer enhanced image of what his face may have looked like.

The study was funded by the National Bank of Egypt, Siemens and the Saint Luke’s Hospital Foundation.