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May 17, 2011

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Scientists surprised to find Egyptian princess had heart disease

May 17, 2011
Courtesy of the European Society of Cardiology
and World Science staff

An Egyp­tian prin­cess had cor­o­nary ar­tery dis­ease more than 3,500 years ago, sci­en­tists say, in find­ings that chal­lenge the con­ven­tion­al idea that heart ill­ness is a mod­ern-day scourge.

“To­day, she would have needed by­pass surgery,” said Greg­o­ry S. Thom­as of the Uni­vers­ity of Cal­i­for­nia, Ir­vine, the stu­dy’s co-principal in­ves­ti­ga­tor, of Prin­cess Ah­mose-Mer­yet-Amon of Egypt. Cor­o­nary ar­tery dis­ease is a blood ves­sel ob­struc­tion that can lead to heart at­tack, an­gi­na and death, and of­ten re­sults from sed­en­tary lifestyles or too much fat­ty food. 

Cal­ci­fi­ca­tion, or tissue hard­ened by de­pos­ition of cal­cium, ap­pears as white in a scan of the mum­my of Prin­cess Ah­mose-Mer­yet-Amon.  Con­sid­ered in­dic­a­tive of cor­o­nary ar­tery dis­ease, cal­ci­fi­ca­tion is seen in the right and left cor­o­nary ar­ter­ies, marked RCA and LCA respectively. (Cour­te­sy ESC)
“Our find­ings cer­tainly call in­to ques­tion the per­cep­tion of ath­er­o­scle­ro­sis as a mod­ern dis­ease,” added Thom­as, whose re­search helped iden­ti­fy ath­er­o­scle­ro­sis—the di­rect cause of cor­o­nary ar­tery dis­ease—in 20 Egyp­tian mum­mies.

The find­ings sug­gest that as a spe­cies we “are pre­dis­posed to ath­er­o­scle­ro­sis,” said co-in­ves­ti­ga­tor Ran­dall C. Thomp­son of the St Luke’s Mid-America Heart In­sti­tute in Kan­sas ­city. This should­n’t prompt peo­ple to give up on ward­ing it off, he stressed, as it re­mains as true as ev­er that prop­er di­et, ex­er­cise and avoid­ance of smok­ing can help do so.

Scanned im­ages of the Egyp­tian roy­al’s cor­o­nary ar­ter­ies are fea­tured in two pre­s­enta­t­ions at the In­terna­t­ional Con­fer­ence of Non-Invasive Car­di­o­vas­cu­lar Im­ag­ing this week in Am­ster­dam. The prin­cess, now the first per­son in his­to­ry with di­ag­nosed cor­o­nary ar­tery dis­ease, lived in Thebes (mod­ern-day Lux­or) in the mid-1500s B.C. Her di­et was rich in veg­eta­bles, fruit and a lim­it­ed amount of meat from do­mes­ti­cat­ed an­i­mals, sci­en­tists said. Bread and beer were the di­etary sta­ples of this pe­ri­od of an­cient Egypt, they added; to­bac­co and trans-fats were un­known, and lifestyles were usu­ally ac­tive.

Thom­as and col­leagues in­ves­ti­ga­ted 52 an­cient Egyp­tian mum­mies for signs of ar­te­ri­al ath­er­o­scle­ro­sis, a hard­en­ing of the ar­ter­ies that leads to cor­o­nary ar­tery dis­ease. They found recog­nis­able ar­ter­ies in 44 mum­mies and an iden­ti­fi­able heart in 16. A mark­er of ath­er­o­scle­ro­sis was ev­i­dent at a va­ri­e­ty of sites in al­most half the mum­mies scanned, prompt­ing the in­ves­ti­ga­tors to note that the con­di­tion was com­mon in this group of mid­dle aged or old­er an­cient Egyp­tians. The 20 mum­mies with def­i­nite ath­er­o­scle­ro­sis were aged 45 years on av­er­age, about 10 years old­er than those with in­tact vas­cu­lar tis­sue but no ap­par­ent ath­er­o­scle­ro­sis.

“Over­all, it was strik­ing how much ath­er­o­scle­ro­sis we found,” said Thom­as.

A CT scan indicated the prin­cess, who died in her 40s, had ath­er­o­scle­ro­sis in two of her three main cor­o­nary ar­ter­ies, lead­ing to a di­ag­no­sis of cor­o­nary ar­tery dis­ease. But how could this “dis­ease of mod­ern life” af­fect a wom­an who probably ate healthy food, and dur­ing a time when la­zy lifestyles were rare? 

Thom­as and co-principal in­ves­ti­ga­tor Adel Al­lam of Al Azhar Un­ivers­ity, Cai­ro, sug­gest three pos­si­bil­i­ties. First, there may­be still some un­known risk fac­tor for cardiovas­cu­lar dis­ease, per­haps an as-yet un­iden­ti­fied ge­net­ic link. Sec­ond, an in­flam­ma­to­ry re­sponse to the fre­quent par­a­sit­ic in­fec­tions com­mon to an­cient Egyp­tians might pre­dis­pose to cor­o­nary dis­ease, much as HIV pa­tients with com­pro­mised im­mune sys­tems seem al­so pre­dis­posed to early cor­o­nary dis­ease. 

Third, a di­etary cause can’t be ruled out. As an aris­to­crat and daugh­ter of Se­qe­nenre Ta­o II, the last phar­aoh of the 17th Dyn­as­ty, the prin­cess’s di­et was probably not that of the com­mon Egyp­tian. She would have ea­ten more lux­u­ry foods such as meat, but­ter and cheese. More­o­ver, foods were pre­served in salt, per­haps pos­ing ad­di­tion­al health risks.

The sci­en­tists are keen not to dis­count those heart dis­ease risk fac­tors we do know about. “Re­cent stud­ies have shown that by not smok­ing, hav­ing a low­er blood pres­sure and a low­er cho­les­ter­ol lev­el, cal­cif­ica­t­ion of our ar­ter­ies is de­layed,” said Thomp­son. “On the oth­er hand, from what we can tell from this stu­dy, hu­mans are pre­dis­posed to ath­er­o­scle­ro­sis, so it be­hooves us to take the prop­er meas­ures nec­es­sary to de­lay it as long as we can.”

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An Egyptian princess had coronary artery disease more than 3500 years ago, scientists say, in findings that challenge the conventional idea of heart illness as a modern-day scourge. “Today, she would have needed bypass surgery,” said Gregory S. Thomas of the University of California, Irvine, the study’s co-principal investigator, of princess Ahmose-Meryet-Amon of Egypt. Coronary artery disease is a blood vessel obstruction that can lead to heart attack, angina and death, and often results from sedentary lifestyles or too much fatty food. “Our findings certainly call into question the perception of atherosclerosis as a modern disease,” added Thomas, whose research helped identify atherosclerosis—the direct cause of coronary artery disease—in 20 Egyptian mummies. The findings suggest that as a species we “are predisposed to atherosclerosis,” said co-investigator Randall C. Thompson of the St Luke’s Mid-America Heart Institute in Kansas City. This shouldn’t prompt people to give up on warding it off, he stressed, as it remains as true as ever that proper diet, exercise and avoidance of smoking can help do so. Scanned images of the Egyptian royal’s coronary arteries are featured in two presentations at the International Conference of Non-Invasive Cardiovascular Imaging this week in Amsterdam. The princess, now the first person in history with diagnosed coronary artery disease, lived in Thebes (modern-day Luxor) in the mid-1500s B.C. Her diet was rich in vegetables, fruit and a limited amount of meat from domesticated animals, scientists said. Bread and beer were the dietary staples of this period of ancient Egypt, they added; tobacco and trans-fats were unknown, and lifestyles were usually active. Thomas and colleagues investigated 52 ancient Egyptian mummies for signs of arterial atherosclerosis, a hardening of the arteries that leads to coronary artery disease. They found recognisable arteries in 44 mummies and an identifiable heart in 16. A marker of atherosclerosis was evident at a variety of sites in almost half the mummies scanned, prompting the investigators to note that the condition was common in this group of middle aged or older ancient Egyptians. The 20 mummies with definite atherosclerosis were aged 45 years on average, about 10 years older than those with intact vascular tissue but no apparent atherosclerosis. “Overall, it was striking how much atherosclerosis we found,” said Thomas. A CT scan shows that the princess, who died in her 40s, had atherosclerosis in two of her three main coronary arteries, leading to a diagnosis of coronary artery disease. But how could this “disease of modern life” affect a woman who probably ate healthy food, and during a time when lazy lifestyles were rare? Thomas and co-principal investigator Adel Allam of Al Azhar University, Cairo, suggest three possibilities. First, there maybe still some unknown risk factor for cardiovascular disease, perhaps an as-yet unidentified genetic link. Second, an inflammatory response to the frequent parasitic infections common to ancient Egyptians might predispose to coronary disease, much as HIV patients with compromised immune systems seem also predisposed to early coronary disease. Third, a dietary cause can’t be ruled out. As an aristocrat and daughter of Seqenenre Tao II, the last pharaoh of the 17th Dynasty, the princess’s diet was probably not that of the common Egyptian. She would have eaten more luxury foods such as meat, butter and cheese. Moreover, foods were preserved in salt, with additional unhealthy effects. The scientists are keen not to discount those heart disease risk factors we do know about. “Recent studies have shown that by not smoking, having a lower blood pressure and a lower cholesterol level, calcification of our arteries is delayed,” said Thompson. “On the other hand, from what we can tell from this study, humans are predisposed to atherosclerosis, so it behooves us to take the proper measures necessary to delay it as long as we can.”