Nov. 18, 2009 -- Rich Egyptians living 3,500 years ago may have been walking around with the same clogged arteries that modern Americans now battle, according to a presentation Monday at the American Heart Association's annual meeting.
A group of scientists said that, on a whim, they performed a computerized tomography (CT) scan on a collection of 22 mummies housed at the Egyptian National Museum of Antiquities in Cairo to see if they too suffered from the plaque build-up in arteries that lead to coronary artery disease.
"We didn't believe it was going to be so intense," said Adel H. Allam, the lead author of a letter to the editor published Tuesday in the Journal of the American Medical Association. "We thought that we would find it, but maybe very rarely, and we thought that if we did find it, it wouldn't be so severe."
The plaque was, of course, long gone. The mummies lived between 1981 B.C. and 364 A.D., and only 16 of the mummies had heart tissue left. However, doctors could see evidence of advanced atherosclerosis (plaque build-up that causes hardening of the arteries) by looking for calcium deposits in a CT scan used to diagnose people today.
Six of the ancient Egyptians likely had atherosclerosis, and four more ancient Egyptians had enough tissue left for the doctors to diagnose them with coronary artery disease.
The oldest mummy to be diagnosed was Lady Rai, a nursemaid of the queen who lived between 1570 and 1530 B.C. and likely died in her 30s.
These same calcium deposits that affected Lady Rai are rare among most of the world's population, but can be found in a large fraction of people in the richest nations today.
"By 45 years old about a quarter of the male population [in the U.S>] has some calcifications in their arteries. When women make it to 55 it's about a quarter of them," said Dr. Jon Keevil, associate professor in the department of medicine and radiology at the University of Wisconsin School of Medicine in Madison.
Keevil explained that when enough plaque builds up in arteries and stays there for a long enough period of time, the artery becomes inflamed and the body lays down calcium deposits in reaction. Typically it takes years of plaque build-up to start calcifications.
Egyptians Had Severely Clogged Arteries?
"We can say it was severe because we saw it in many of the arteries and this was enough proof to say it was extensive," said Allam, of the Al Azhar Medical School in Cairo.
Allam couldn't say whether the mummies died from heart disease, but he has seen evidence in ancient Egyptian writings that hint that people then had chest pains and heart trouble like we do.
"In some of the papyrus, we discovered that actually the priests gave a good description of chest pain, of angina," Allam said. "If angina has been described 3,500 years ago by the priests -- the people who were taking care of the people at the time -- then probably the disease did exist."
Given what Egyptologists know about the diet of the Egyptian elite, the only people rich enough to afford the labor-intensive mummification process, many cardiologists aren't surprised that they had clogged arteries.
Then and Now: What We Eat and Heart Disease
"You should assume that the ancient Egyptian elite lived as well as they could, they would have eaten meat and drank beer, too," said John Baines, professor of Egyptology at the University of Oxford, England.
Baines said paintings of people in ancient Egypt show the society was just as conflicted about body image ideals, health and wealth as modern Western society.
"Depending on the period, you can look and see there was a body ideal of being slim, especially for women. If you're a man you should be muscular, but slim, and if you're a woman you should be quite slim," Baines said.
At the same time, Baines said, many rich men would be portrayed as thin in some paintings and portly in others.
"You do also have a prosperous fat idea for men, but it was absent for women," he said. "That being fat means you are successful, and prosperous, and so you could afford to eat."
With so many pictures of servants carrying the elite, or offering them lavish displays of meat, Baines said he wasn't surprised at all that rich ancient Egyptians had heart disease.
Allam also pointed out another risk factor in the ancient Egyptians' meals that also plagues modern people's diets: salt.
"Because there were no refrigerators, they used a lot of salt," Allam said. "They used to salt the meat and the fish to keep it a long time, and this led to an increase in high blood pressure."
While the bad diets weren't a surprising link to heart disease in ancient Egypt, Allam and other doctors said they were shocked by how much plaque must have built up in these Egyptians even before their 50th birthday.
Even Young Egyptians Had Heart Disease
Baines said ancient Egyptians lived "not very long, that would be the basic view," even if someone was in the higher classes and could avoid malnourishment and some diseases that plagued the poor.
"The average life expectancy was extremely low," Baines said. For example, he said, often a group of wealthy people would be buried together "and sometimes age of death is given, and they died in their 20s. They are members of the elite because they got little inscriptions saying the age."
Indeed, the oldest mummy examined by the researchers with a CT scan only reached age 45. Allam said the degree of plaque in mummies who didn't smoke and didn't have as much access to bad foods as the modern person should be a huge wake-up call to people living today.
"Despite our efforts to reduce smoking and improve our diet and increase exercise, our risk factor profile is considerably worse than the ancient Egyptians -- and they had coronary artery disease in their 30s," said Dr. James Januzzi, director of the Cardiac Intensive Care Unit at Massachusetts General Hospital in Boston and an associate professor of medicine at Harvard University.
"I suspect that if you scanned the same 22 adults in our modern culture I think you'd find similar results," Januzzi said.
Januzzi said he often sees people in their 30s come into his office with plaque, or worse, after having suffered a heart attack. Although he's noticed people this age like to think they are "indestructible," he said, they too should try to eat right, exercise or even see a doctor about blood pressure medication if necessary.
"You're never too young to begin the preventive steps to avoid a cardiac event," he said.
Dr. Sidney Smith of the University of North Carolina at Chapel Hill agreed.
"Just like us, our ancestors were vulnerable to atherosclerosis (hardening of the arteries): mummies examined were reportedly upper class and middle class and may have had access to a fat-laden, unhealthy diet which contributed to the development of their disease," Smith told Med Page Today at the annual American Heart Association meeting in Orlando, Fla. "Food other than that which comes in packages can also do us in."