Académique Documents
Professionnel Documents
Culture Documents
4, 2011
ORIGINAL RESEARCH
O B J E C T I V E S The purpose of this study was to determine whether ancient Egyptians had
atherosclerosis.
R E S U L T S Forty-four of 52 mummies had identiable cardiovascular (CV) structures, and 20 of these had
either denite atherosclerosis (dened as calcication within the wall of an identiable artery, n 12) or
probable atherosclerosis (dened as calcications along the expected course of an artery, n 8).
Calcications were found in the aorta as well as the coronary, carotid, iliac, femoral, and peripheral leg
arteries. The 20 mummies with denite or probable atherosclerosis were older at time of death (mean age
45.1 9.2 years) than the mummies with CV tissue but no atherosclerosis (mean age 34.5 11.8 years, p
0.002). Two mummies had evidence of severe arterial atherosclerosis with calcications in virtually every
arterial bed. Denite coronary atherosclerosis was present in 2 mummies, including a princess who lived
between 1550 and 1580 BCE. This nding represents the earliest documentation of coronary atherosclerosis
in a human. Denite or probable atherosclerosis was present in mummies who lived during virtually every
era of ancient Egypt represented in this study, a time span of 2,000 years.
From the *Al Azhar Medical School, Cairo, Egypt; St. Lukes MidAmerica Heart Institute, Kansas City, Missouri;
University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Wisconsin Heart Hospital, Milwaukee,
Wisconsin; Mission Internal Medical Group, Mission Viejo, California; University of California, San Diego School of
Medicine, San Diego, California; #Cairo University, Cairo, Egypt; **Bibliotheca Alexandrina, Alexandria, Egypt; National
Research Center, Giza, Egypt; Institute of Restoration, Alexandria, Egypt; Newport Diagnostic Center, Newport Beach,
California; South Coast Radiologic Medical Group, Laguna Hills, California; and the University of California, Irvine
School of Medicine, Orange, California. This work was funded by the Paleocardiology Foundation from contributions by
Siemens, the National Bank of Egypt, St. Lukes Hospital Foundation, and various individual donors. All authors have reported
that they have no relationships to disclose.
Manuscript received January 8, 2011; revised manuscript received January 26, 2011, accepted February 1, 2011.
C
ardiovascular diseases are the worlds larg- METHODS
est killers, claiming 17 million lives in
2010. Our 21st century epidemic of car- Study population. We, the Horus study team, per-
diovascular disease continues to spread formed whole body 6-slice CT using a Siemens
from wealthy, developed areas of the world to Emotion 6 (Florsheim, Germany) on 45 mummies
poorer, developing countries (1). Deaths due to housed in (or in the case of 2 of these mummies,
cardiovascular diseases, primarily related to an in- brought to) the Egyptian National Museum of
crease in the prevalence of atherosclerosis, is pro- Antiquities in Cairo. We selected adult mummies
jected to increase to 23 million per year by 2030 for inclusion from multiple historical eras from the
(2). As the diet, lifestyle, and environmental risk museums collection of 120 to 140 mummies on the
factors for the development of atherosclerosis basis of their apparent good state of preservation,
spread from developed nations to the rest of the which was expected to increase the likelihood that
world, cardiovascular disease follows. It is tempt- intact vascular tissue would be present. We did not
ing to conclude that atherosclerotic cardiovascular randomly select mummies for inclusion. The vas-
disease is exclusively a disease of modern society cular bed findings of mummies #1 through #22
and did not affect our ancient ancestors. The have been reported in brief previously (9). In the
findings of the present study provide evidence to the current publication, the cardiovascular findings of
contrary. these mummies, as well as the additional 30 mum-
Atherosclerosis was first identified in ancient mies, are described in greater detail after compre-
Egyptians when Johann Nepomuk Czermak found hensive review of the entire 52-mummy cohort.
calcific aortic atherosclerosis during an autopsy of We scanned 42 mummies specifically for this
the mummy of an elderly Egyptian woman in 1852 study in February 2009 and May 2010. We also
(3). One hundred years ago, Sir Marc Armond included 3 additional mummies housed in the
Ruffer also identified histologic evidence Egyptian National Museum of Antiquities. They
ABBREVIATIONS
of atherosclerosis in the aorta as well as in were included in this study because cardiovascular
AND ACRONYMS other large arteries on autopsies performed tissue was known to be present in 2 mummies, and
on multiple 3,000-year-old Egyptian 1 mummy was the subject of a post-graduate thesis
CT computed tomography mummies (4). In 1931, Allen Long exam- of 1 of the authors (I.B.).
CV cardiovascular ined the heart of Lady Teye, a mummy in We obtained demographic information through
the collection of the Metropolitan Mu- an extensive search of museum and other resources
seum in New York, who lived during the 21st by a team of experienced Egyptologists and experts
dynasty (1070 to 945 BCE), finding histologic in mummy restoration (I.B., G.A.M., and A.H.N.).
evidence of coronary atherosclerosis, with intimal We determined sex through biological anthropo-
thickening and calcification in the epicardial coro- logic assessment of the genital/reproductive organs
nary arteries, as well as areas of fibrosis in the and morphology of the pelvis, femur, and skull. A
myocardium consistent with prior myocardial in- biologic anthropologist (M.A.T.S.) estimated the
farction (5). Anatomists and physicians commonly age at death through integrative assessment of the
performed autopsies of Egyptian mummies a cen- architectural changes in the clavicle, humerus, and
tury ago, but these have since fallen out of favor femur (12,13). If all of these bones were available,
given the destructive nature of the process. and each method resulted in the same age, he
Atherosclerosis emanates from a complex inter- estimated a specific age. If only 2 of 3 methods were
play of genes and environment (6 8), and the concordant, he estimated an age range. If bones
etiology of the ongoing epidemic is certainly mul- were available for only 2 methods and were concor-
tifactorial. However, the study of ancient Egyptian dant, he also provided an age range. If only 2
mummies may provide unique insights into the methods were applicable and were discordant, he
ancestral origins of atherosclerosis. We (9,10) and provided a larger age range.
others (11) have begun to use modern X-ray com- The Egyptian/U.S. research team submitted a
puted tomography (CT) to examine these ancient formal scientific proposal, written in Arabic, for
humans in a nondestructive fashion. We report here each individual expedition to the Supreme Council
our findings using CT to systematically search for of Antiquities of Egypt, a body of 70 professors of
evidence of arterial calcification as a marker for Egyptology. The team was granted approval for
cardiovascular disease in 52 ancient Egyptian each proposal, including the ability to image the
mummies. mummies, by majority vote. We obtained clinical
informed consent from the contemporary human Chicago, Illinois). A p value 0.05 was considered
patients whose CT images we used for comparison. significant. We investigated possible sex differences
CT imaging. We used the Siemens Emotion 6 scan- in age at death, and atherosclerosis status, using
ner to image the 45 mummies at the Museum of Student t and chi-square tests, respectively. We also
Antiquities. We imaged the thorax, abdomen, pel- used individual binary logistic regressions to deter-
vis, and extremities at 130 kv with 1.25 mm mine whether the odds of having atherosclerosis
collimation and 50% overlap. We imaged the head would increase with advancing age and be greater in
and neck at 130 kv with 0.6 mm collimation and later chronological eras. We used chi-square to test
50% overlap. Using a similar technique with a GE the potential (11,15) that priests/priestesses would
LightSpeed-Plus 4-slice scanner (Pewaukee, Wis- be more likely to have atherosclerosis than non-
consin), we also scanned 6 Egyptian mummies at clergy. Lastly, among the subset of mummies who
the Bowers Museum (Santa Ana, California) and had atherosclerosis, we tested the hypothesis that
were provided the images from a GE LightSpeed older mummies would have a more severe form of
Ultra 8-slice scanner of another Egyptian mummy the disease (as defined by greater number of vascular
currently housed at the Nelson-Atkins Museum beds affected) using chi-square. For this analysis, we
(Kansas City, Missouri). Therefore, the total sam- divided the sample into those younger versus older
ple comprised 52 mummies. than 40 years, as this age threshold is consistent
Image interpretation. Seven experienced cardiovas- with an accepted risk factor for coronary artery
cular imaging physicians (A.H.A., M.I.M., J.D.S., disease and was roughly equivalent to the mean age
M.L.S., G.S.T., R.C.T., and L.S.W.) collabora- of death in the present sample.
tively identified cardiovascular tissue and ascer-
tained the presence or absence of calcification in the
RESULTS
vessel walls and heart. Image reformatting and
measurements of the thickness and X-ray attenua- Sample characteristics. The demographics and car-
tion (Hounsfield units) of various structures were diovascular findings of the 52 ancient Egyptian
made using a Siemens multimodality imaging mummies are displayed in Table 1. Online Supple-
workstation. The Apple platform OsiriX DICOM mental Table 1 complements this table with the
viewing software (version 3.81, Geneva, Switzer- place of excavation and the museum ascension
land) was also utilized to facilitate consensus image number. The mummies lived between 1981 BCE
review. Vascular tissue and the heart were identified and 364 CE. Mean estimated age at death was
by their anatomic position in the body and relation- 38.1 12.0 years (ranging from 10 to 60 years).
ship to contiguous structures, enhanced by the use Sex could be determined for all except for the
of 3-dimensional multiplanar reconstruction and youngest 2 mummies who were prepubescent. The
maximum intensity projection reconstructions. The mean age at death did not differ by sex (40.0 10.2
presence of calcification in the vessel wall was years for the 33 men, and 37.6 12.4 years for the
defined qualitatively by comparing multiple regions 17 women, p 0.26). We determined the social
within visualized cardiac and vascular tissue to one position for 25 mummies, and each of these was of
another. Noncontrast CT images obtained from 2 high socioeconomic status. Again, although the
contemporary patients with known vascular disease social position of the remaining 27 mummies is
were included for comparison and illustration and unknown, the financial costs of mummification
to help identify anatomic landmarks. suggest that they too were likely of high socioeco-
As described previously (9), calcification in the nomic status. We determined the place of excava-
vessel wall of a clearly identifiable artery was con- tion for 43 mummies. Each of these was excavated
sidered diagnostic of atherosclerosis. Calcification either near the Nile River or at an oasis in Upper
along the expected course of an artery was consid- Egypt, an area that is now the southern part of
ered to be probable atherosclerosis. modern Egypt.
Arterial vascular regions were divided into the 5 Computed tomography images demonstrated
distinct beds modified from the method of Allison identifiable vascular tissue in 43 mummies. An
et al. (14): the carotid, coronary, aortic, iliac, and intact heart or heart remnants could be identified in
femoral/popliteal/tibial (termed peripheral) vascular 31 mummies. One mummy had an intact heart
beds. without vessels present, yielding 44 mummies with
Statistical analysis. Statistical analysis was per- cardiovascular (CV) tissue who could be evaluated
formed using SPSS software (version 16 for Mac, for atherosclerosis (27 male, 16 female, 1 unknown).
Femoral/
APRIL 2011:31527
27/M/2530 Unknown Unknown New Kingdom, 15501295 BCE
18th Dynasty
28/M/4045 Unknown Unknown Late ca. 688332 BCE
Continued on next page
Femoral/
Popliteal/
Mummy #/ Remnants Atherosclerosis
Carotids Coronaries Aorta Iliac Tibial
Sex/ Social Position/ Vascular Tissue of Heart; ( Denite;
Age (yrs) Name Occupation Period Period Years ( Present) Intact Heart Probable) ( Calcication Seen in Vascular Bed)
29/M/4550 Unknown Unknown Late ca. 688332 BCE
30/M/4550 Unknown Unknown Late ca. 688332 BCE
31/M/4550 Djedhor, Son of King Late 380343 BCE
Nesihor
32/M/30 Unknown Unknown Greco-Roman 332 BCE364 CE
33/F/4050 Unknown Queen New Kingdom, 15501295 BCE
18th Dynasty
34/F/4045 Ahmose- Queen 2nd Intermediate, 15801550 BCE
Henttamehu 17th Dynasty
35/F/4045 Unknown Princess 2nd Intermediate, 15801550 BCE
17th Dynasty
36/F/2025 Ahmose- Princess 2nd Intermediate, 15801550 BCE
Henutempet 17th Dynasty
37/F/19 Unknown Unknown Roman 30 BCE364 CE
38/F/4550 Unknown Unknown Unknown Unknown
39/M/3540 Unknown Unknown Unknown Unknown
40/M/4550 Nebsy Unknown New Kingdom ca. 15501070 BC
41/M/3540 Djedhor Unknown Unknown Unknown
42/F/4550 Taditbastet Unknown 3rd Intermediate, ca. 700 BCE
25th Dynasty
43/F/2025 Shauenimes Unknown 3rd Intermediate, 945710 BCE
22nd Dynasty
44/M/2530 Unknown Unknown Late ca. 688332 CE
45/?/12 Tjayasetimu Singer of 3rd Intermediate, ca. 900 BCE
Interior of 22nd Dynasty
Allam et al.
51/M/4555 Unknown Unknown Late Intermediate 500 BCE
52/M/2530 Gitbetah High Priest 3rd Intermediate, 828725 BCE
of Amun 23rd Dynasty
Mummies were numbered in the order that they were scanned and/or their images reviewed. This numbering system differs from the one employed in our previous report (9), in which mummies were ordered by estimated chronological age. See
the Online Appendix for place of excavation and museum accession number.
319
Downloaded From: http://imaging.onlinejacc.org/ on 04/09/2013
320 Allam et al. JACC: CARDIOVASCULAR IMAGING, VOL. 4, NO. 4, 2011
Computed tomography maximum intensity projection showing heavy calcications (arrows) in the common iliac arteries on (A) axial and (B)
coronal projections in the mummy of a princess who lived during the Second Intermediate Period (Mummy #35). Also see Online Video 1.
(A) Reoriented coronal thick slab 3-dimensional, multiplanar reconstruction window adjusted for vascular calcication, computed tomog-
raphy image of the mummy of a princess who lived during the Second Intermediate Period shows calcications in the coronary and iliac
arteries, indicating this person had diffuse atherosclerosis. The posterior descending and posterolateral branches of the right coronary
artery can be discerned distal to calcications of the proximal and mid right coronary (Mummy #35). (B) Computed tomography scan
from a modern Egyptian patient showing similar calcications in the coronary and iliac arteries. Also see Online Video 2. LCA left cor-
onary artery; RCA right coronary artery.
we were unable to definitively determine the cause of heart remnants in 15 (29%), of the 52 mummies
death for any of the 52 mummies. Representative imaged. Hearts could be identified in mummies of
examples of mummies with carotid, aortic, and pe- all historic periods (Table 1). Two of those with
ripheral vascular atherosclerosis are shown in intact hearts had definite coronary atherosclerosis,
Figures 2 to 6. and 1 had probable coronary atherosclerosis. Exam-
Cardiac ndings. Of the 31 mummies with hearts ples of coronary artery calcifications are seen in
present, an intact heart was present in 16 (31%) and Online Video 1 and in Figures 3A, 7, and 8A. The
mean age of mummies with coronary atherosclero-
sis was 48.3 6.3 years. This is nominally greater
than the mean age for the entire sample, although
the small sample size precluded us from performing
inferential statistics.
Mitral annular calcification was present in 2 (6%)
of the 31 mummies with intact or remnant hearts
(Fig. 9).
Socioeconomic status and atherosclerosis. Among
the 25 mummies for whom social position could be
determined, 10 were priests or priestesses. Athero-
sclerosis was less common in clergy than in non-
clergy (p 0.012).
The historical era in which the individuals lived was
known for 41 of the 44 mummies with cardiovascular
tissue present. At least 1 mummy with atherosclerosis
was found in all eras except the Middle Kingdom, in
which only 1 mummy (no vascular tissue present) was
Figure 4. Atherosclerosis in the Supercial Femoral Arteries available for scanning (Fig. 10). In a logistic regres-
Computed tomography maximum intensity projection of the sion, historical era was not predictive of atherosclerosis
upper legs showing extensive calcications along the course of status (p 0.23). Thus, atherosclerosis was not more
the supercial femoral arteries in the mummy of a man who
lived during the 18th Dynasty (Hatiay, Mummy #23).
prevalent in later historic periods than in earlier ones
(odds ratio: 0.74, p 0.24).
Axial computed tomography images of the left leg distal to the knee showing (A) calcications in the popliteal artery (arrow), and (B) in
a slightly distal position, showing calcications in the peroneal artery and the anterior tibial artery (arrows) in the mummy of a woman
who lived during the Ptolemaic Period (Mummy #22).
Computed tomography maximum intensity projection sagittal view (A) showing heavy calcications in the region of the left carotid
artery at the carotid bulb (arrow), and (B) axial view showing heavy calcications in the region of both the right and left carotid bulbs
(arrows) in the mummy of man who lived during the 18th Dynasty (Hatiay, Mummy #23).
(A) Maximum intensity projection computed tomography image showing calcications of the left coronary artery (arrow). (B) Anthropoid
mask of the same mummy, a man who lived during the Ptolemaic Period (Djeher, Mummy #12).
(A) Heavy calcications in the region of the mitral annulus (arrow) in the heart of a mummy of a woman who lived in ancient Egypt
(Mummy #38). See Online Video 3 for a video of the mitral valve calcication as well as aortic and iliac calcication. (B) Similar appear-
ance of heavy mitral annular calcication (arrow) in a noncontrast computed tomography scan performed in a modern patient.
ritual feasts left by families mourning their deceased exercised in generalizing our results to the entire
relatives. Relative to atherosclerosis, however, in ancient Egyptian population.
this relatively small subset we found priests and Elite and nonelite ancient Egyptians were not
priestesses to have less atherosclerosis than non- hunter-gatherers, however. Profound changes be-
clergy. Nevertheless, significant differences may gan to occur in human lifestyles and diet around
have existed between the food consumed by royalty 10,000 years ago with the introduction of agricul-
and other elites and that eaten by common farmers ture and animal husbandry. Egyptians had formed
and laborers (19). As the elite were more likely to be an organized agricultural society along the Nile that
mummified after death, caution must therefore be long predated the mummies that we studied. It is
The presence of identiable cardiovascular tissue and atherosclerosis found in the mummies is shown in relation to the ancient Egyptian
eras in which they lived. Atherosclerosis was found in virtually all time periods represented in the study. Open boxes indicate cardiovas-
cular (CV) tissue, no atherosclerosis; solid circles represent denite or probable atherosclerosis.
plausible that the composition of their diet contrib- Allison et al. (14) reported the prevalence of
uted to the development of atherosclerotic cardio- vascular calcifications in 650 asymptomatic contem-
vascular disease (11,15,19,20). porary men and women (mean age 57.6 years) using
Study limitations. To assess the presence of athero- whole body CT imaging. Among those age 50 to 60
sclerosis, we used CT findings of arterial calcifica- years, vascular calcification was present in 92% of
tion as a marker. We did so given that vascular the men and 72% of the women, and present in 2 or
calcification is generally regarded as a highly spe- more vascular beds in 80% of the men and 62% of
cific, late-stage manifestation of atherosclerosis. the women. By the time men reached 60 years of
Whereas the earliest pathologic manifestations of age and the women reached 70 years of age, all had
atherosclerosis include intimal thickening and fatty calcification in 1 or more vascular beds. A direct
streaks, complex changes occur as the disease pro- comparison of the prevalence of atherosclerosis
gresses, with structural remodeling of the vessel, among the ancient Egyptians imaged in this current
cellular infiltrates, lipid accumulation, thrombosis, study to contemporary humans is difficult given the
fibrosis, and calcification involving the media as frequently missing vessel beds and younger age at
well as the adventitia (21). death among the ancient Egyptians.
We have no independent pathologic verification Although we could not determine the presence or
that areas of arterial calcification, which we identi- absence of clinical disease syndromes associated
fied by expert consensus interpretation of these with atherosclerosis in these ancient humans, ex-
noncontrast CT images, actually represent athero- trapolation of findings from modern vascular epi-
sclerotic plaque. Our interpretations are based on demiological studies suggest a significant likelihood
our knowledge of arterial anatomy, the similarity of of such disease. Many of the mummies we studied
the appearance and observed age-related prevalence had arterial calcification in the pelvis and legs, areas
of vascular calcification in modern patients and that were relatively better preserved in these ancient
mummies, and the fact that histologic studies humans than the coronaries or carotids. It has been
showing arterial calcification in a similar vascular shown that an increasing degree of tibial artery
distribution in mummies have been previously re- calcification, as measured by CT, identifies increas-
ported (35,11). ing severity of peripheral arterial disease and iden-
For the majority of the mummies, we used a 6-slice tifies patients with a higher risk for amputation,
scanner to acquire thin CT axial images, reconstruct- independent of traditional risk factors (25). Calci-
ing images in multiple 2- and 3-dimensional planes. fication of the lower extremity arteries, more com-
Recently developed CT scanners with larger detector mon in diabetic patients and patients with renal
arrays for wider coverage per rotation and employing failure, is a strong predictor of adverse outcomes
strategies for better temporal resolution could be used due to associated coronary heart disease (26,27).
but offer little advantage for imaging of the motionless Arterial calcification was also seen in the aortas and
mummies. However, newer machines with improved carotid arteries of these mummies. Many studies
spatial resolution and machines employing multiple have shown an association between aortic and
X-ray energies might improve plaque characterization. coronary atherosclerosis and with aortic aneurysm,
Dual-energy CT might be useful in differentiating renal failure, and stroke, all of which share common
calcium hydroxyapatite associated with atherosclerotic risk factors (28). The estimated mean age at the
plaque from natron (sodium carbonate decahydrate), a time of death of the mummies we studied was
salt used in the mummification process. 38.1 12.0 years, a relatively old age 3 millennia
Implications. As civilization advanced, humans sur- ago. Several mummies had such diffuse generalized
vived to older ages. Before the modern era, infec- atherosclerosis that clinical symptoms would seem
tious disease, trauma, and famine were the most to have been likely.
common causes of death. Perhaps genetic adapta- Ancient Egyptian hieroglyphic papyri texts men-
tion favored a beneficial inflammatory response to tion symptoms consistent with angina, acute myo-
infection, markedly helpful in childhood and cardial infarction, and congestive heart failure (29).
through the reproductive years in ancient civiliza- For example, an ancient Egyptian papyrus for
tions, but which potentially promoted the devel- physicians comments, If thou examinist a man for
opment of atherosclerosis later in life (22,23). We illness in his cardia, and he has pains in his arms, in
now recognize that inflammation plays an impor- his breasts and on 1 side of his cardia . . . it is death
tant role both in atherosclerosis (6,8,24) and threatening him (30). Relief sculptures found in
advancing age (22). ancient Egyptian tombs have been interpreted as
showing sudden death, with a nobleman collapsing and McLean Hospitals and Noah Shamosh, PhD,
in the presence of his servants (31). of an international strategy consulting firm; Mary
Our findings of frequent arterial calcification Hochman, MD, Harvard Medical School/Beth
suggest that atherosclerotic cardiovascular disease Israel Deaconess Medical Center for providing us
was present and commonplace in ancient Egypt, with the images of 1 of the mummies; Sallam
raising intriguing questions regarding the nature Lotfy Mohamed, BSc, of Alfascan, Cairo, Egypt
and extent of human predisposition to the develop- for technical imaging support, and John Labib,
ment of atherosclerosis. BA, of the University of Lincoln, United King-
dom, for his background research and assistance
Acknowledgments
with scanning.
The authors express their thanks to the Supreme
Council of Antiquities, Egyptian Ministry of Cul- Reprint requests and correspondence: Dr. Gregory S.
ture, for allowing us to image these mummies; Thomas, Mission Internal Medical Group, 26800 Crown
statistical consultants, Jennifer J. Thomas, PhD, Valley Parkway, Suite 120, Mission Viejo, California
Harvard Medical School/Massachusetts General 92691. E-mail: gthomas9@mac.com.
REFERENCES 11. David R. Cardiovascular disease and cification to cardiovascular risk fac-
diet in ancient Egypt. In: Hawass Z, tors: the Multi-Ethnic Study of Ath-
1. Reddy KS, Yusuf S. Emerging epi- Woods A, editors. Egyptian Culture erosclerosis (MESA). Atherosclerosis
demic of cardiovascular disease in de- and Society: Studies in Honor of 2010;213:558 62.
veloping countries. Circulation 1998; Naguib Kanawati. Annales du Service 19. Darby WJ, Ghallounghul P, Grivatti
97:596 601. des Antiquites de lEgypte. Vol. 1. L. Food: The Gift of Osiris. Vol 1.
2. World Health Organization. World Cairo, Egypt: Conseil Supreme des London: Academic Press, 1957.
Health Statistics 2010. Geneva: Antiquites de lEgypte, 2010:10517. 20. Cordain L, Eaton SB, Sebastian A, et
World Health Organization Press, 12. Buikstra JE, Ubelaker DH. Standards al. Origins and evolution of the West-
2010. for Data Collection from Human ern diet: health implications for the
3. Czermack J. Description and micro- Skeletal Remains. Arkansas Archeo- 21st century. Am J Clin Nutr 2005;
scopic findings of two Egyptian mum- logical Survey Research Series No. 44. 81:34154.
mies. Meeting of the Academy of Fayetteville, AR: Arkansas Archeo- 21. Stary HC, Chandler AB, Dinsmore
Science (Beschreibung und mikrosko- logical Survey, 1994. RE, et al. A definition of advanced
pische Untersuchung Zweier Agyp- 13. Walker RA, Lovejoy CO. Radio- types of atherosclerotic lesions and a
tischer Mumien, S.B. Akad. Wiss. graphic changes in the clavicle and histological classification of athero-
Wien), 1852;9:27. proximal femur and their use in the sclerosis. A report from the Commit-
4. Ruffer MA. On arterial lesions found in determination of skeletal age at death. tee on Vascular Lesions of the Council
Egyptian Mummies (1580 BC535 AD). Am J Phys Anthropol 1985;68:6778. on Arterosclerosis, American Heart
J Pathol Bacteriol 1911;16:453 62. 14. Allison MA, Criqui MH, Wright Association. Circulation 1995;92:
5. Long AR. Cardiovascular renal dis- CM. Patterns and risk factors for sys- 135574.
ease: a report of a case three thousand temic calcified atherosclerosis. Aterio- 22. Finch C. The Biology of Human Lon-
years ago. Arch Pathol (Chic) 1931; scler Thromb Vasc Biol 2004;24; gevity: Inflammation, Nutrition and
12:92 4. 331 6. Aging in the Evolution of Life Spans.
6. Ridker PM. On evolutionary biol- 15. David R. The art of medicine Amsterdam: Academic Press, 2007.
ogy, inflammation, infection, and the atherosclerosis and diet in ancient 23. Sawabe M. Vascular aging: from mo-
causes of atherosclerosis. Circulation Egypt. Lancet 2010;175:718 9. lecular mechanism to clinical signifi-
2002;105:2 4. 16. Budoff MJ, Achenbach S, Blumenthal cance. Geriatr Gerontol Int 2010;10
RS, et al. Assessment of coronary Suppl:213330.
7. Falk E. Pathogenesis of atheroscle-
artery disease by cardiac computed 24. Finch CE. Evolution of the human
rosis. J Am Coll Cardiol 2005;47:
tomography: a scientific statement lifespan and diseases of aging: roles of
C712.
from the American Heart Association infection, inflammation, and nutri-
8. Ding K, Kullo I. Evolutionary genet- Committee on Cardiovascular Imag- tion. Proc Natl Acad Sci U S A
ics of coronary heart disease. Circula- ing and Intervention, Council on Car- 2010;107 Suppl 1:1718 24.
tion 2009;119:459 67. diovascular Radiology and Interven- 25. Guzman JR, Brinkley DM, Schum-
9. Allam AH, Thompson RC, Wann tion, and Committee on Cardiac acher PM, Donohue RMJ, Beavers H,
LS, Miyamoto ML, Thomas GS. Imaging, Council on Clinical Cardi- Qin X. Tibial artery calcification as a
Computed tomographic assessment of ology. Circulation 2006;114:176179. marker of amputation risk in patients
atherosclerosis in ancient Egyptian 17. Allison MA, Cheung P, Criqui MH, with peripheral arterial disease. J Am
mummies. JAMA 2009;302:20913. Langer RD, Wright CM. Mitral and Coll Cardiol 2008;51:196774.
10. Allam AH, Nureldin A, Adelmak- aortic annular calcification are highly 26. Lehto S, Niskanen L, Suhonen, et al.
soub G, et al. Something old, some- associated with systemic calcified ath- Medial artery calcification. A ne-
thing new computed tomography erosclerosis. Circulation 2006;113: glected harbinger of cardiovascular
studies of the cardiovascular system in 861 6. complication in non-insulin depen-
ancient Egyptian mummies. Am 18. Kanjanauthai S, Nasir K, Katz R, et dent diabetes mellitus. Arterioscler
Heart Hosp J 2010;20:10 3. al. Relationships of mitral annular cal- Thromb Vasc Biol 1996;16:978 83.