Have you ever heard of "atherosclerosis"? It is probably something that is more common than you think. Atherosclerosis is the hardening of the arteries and is the end result of the inevitable age-related accumulation of cholesterol and lipids (fats), cell debris, which ultimately calcifies and becomes hard. This gradually clogs the artery and restricts blood flow. The plaque that forms on the vessel lining is called an atheroma. Sclerosis is the stiffening of tissue due to an increase of fibrous and inflammatory tissue. When an atheroma forms in a blood vessel over decades of life, it becomes fibrotic and ultimately calcified, and we refer to the process as Atherosclerosis. Arteriosclerosis is the same thing. It affects the arteries of the heart, neck, brain, bowel, kidneys, and the major arteries to our legs. Since it develops slowly and without any symptoms, and remains harmless for may years, it is virtually impossible to stop. The best we can hope for is to slow its progression enough to prolong our lives.
Arteriosclerosis has often been thought of as a disease of the modern era, with our fatty diets, high blood pressure, and constant life stress. But studies of pre-industrial and even pre-agricultural societies 4000 years ago provide evidence to the contrary. CT scans of mummies from ancient Egypt, the Roman Era, Ancient Peru, and Inuit from ancient Alaska and from Greenland all show atherosclerosis in 25 – 40% of specimens studied. That means that it is not necessarily only a modern disease, but instead may be as old as mankind. Perhaps some of your own ancestors had atherosclerosis!
The first research identifying cholesterol as a key in the development of atherosclerosis was published in 1913. Groundbreaking work in the 1950’s led to the Statin medications that lower cholesterol. Dietary intervention trials were conducted in the 1960’s, and by 1970, research firmly concluded that cholesterol lowering could be achieved. It was not until 1984 however that decreased cholesterol in the blood was associated with a reduced risk of coronary artery disease.
Since 90% of adults in the US older than 30 years have atherosclerosis, and it is responsible for 75% of the heart related deaths each year, we should do all we can to control our risk factors. Some risks we can control, like high blood pressure, smoking, and dietary lipids. Some risk factors are fully beyond our control, like family history. Healthy eating of a balanced low-fat diet mixed with regular exercise and avoiding smoking will reduce risk. Further lowering of cholesterol and blood pressure by medication use is important where it is applicable. Everyone can also benefit from adjunctive therapies that have been proven such as niacin, fibrates, plant stanols, omega-3 fatty acids.
Just as our modern era and culture struggle with atherosclerosis, your ancestors did also. Lucky for us, we now know of this and can do our best to treat and mitigate it. May your arteries harden very slowly!
Dennis G. Crandall, MD
Clinical Professor, University of Arizona School of Medicine
Adjunct Associate Professor, Mayo Clinic College of Medicine and Sciences
Sonoran Spine Research Foundation
Further reading:
1. Thompson RC, Allam AH, Lombardi GP, et al. Atherosclerosis Across 4000 Years of Human History: The Horus Study of Four Ancient Populations. Lancet 2013;381:1211-22.
2. Wann L, Narula P, Blankstein R, et al. Atherosclerosis in 16th-Century Greenlandic Inuit Mummies. JAMA Network Open. 2019;2(12):e1918270. doi:10.1001/jamanetworkopen.2019.18270
3. Steinberg D. In celebration of the 100th anniversary of the lipid hypothesis of atherosclerosis. J. Lipid Res. 2013.54:2946-50.
4. Steinberg D. An interpretive history of the cholesterol controversy, part V: The discovery of the statins and the end of the controversy. J. Lipid Res. 2006. 47:1339–1351.
5. Lewis S. Prevention and treatment of atherosclerosis: a practitioner’s guide for 2008. Am J Med 2009. 122(1 Suppl):S38-50.
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