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Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study

The Lancet (British edition), 2017-04, Vol.389 (10080), p.1730-1739 [Peer Reviewed Journal]

Elsevier Ltd ;2017 Elsevier Ltd ;Copyright © 2017 Elsevier Ltd. All rights reserved. ;Copyright Elsevier Limited Apr 29, 2017 ;ISSN: 0140-6736 ;EISSN: 1474-547X ;DOI: 10.1016/S0140-6736(17)30752-3 ;PMID: 28320601

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Title:
Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study
Author: Kaplan, Hillard, Prof ; Thompson, Randall C, Prof ; Trumble, Benjamin C, PhD ; Wann, L Samuel, MD ; Allam, Adel H, Prof ; Beheim, Bret, PhD ; Frohlich, Bruno, Prof ; Sutherland, M Linda, MD ; Sutherland, James D, MD ; Stieglitz, Jonathan, PhD ; Rodriguez, Daniel Eid, MD ; Michalik, David E, DO ; Rowan, Chris J, MD ; Lombardi, Guido P, MD ; Bedi, Ram, PhD ; Garcia, Angela R, MA ; Min, James K, Prof ; Narula, Jagat, Prof ; Finch, Caleb E, Prof ; Gurven, Michael, Prof ; Thomas, Gregory S, Prof
Subjects: Adult ; Adults ; Age Distribution ; Aged ; Aged, 80 and over ; Anthropometry - methods ; Arteriosclerosis ; Atherosclerosis ; Atherosclerosis - blood ; Atherosclerosis - diagnostic imaging ; Atherosclerosis - ethnology ; Atherosclerosis - etiology ; Biomarkers ; Blood pressure ; Bolivia - epidemiology ; C-reactive protein ; Calcification (ectopic) ; Calcium ; Cardiovascular disease ; Cardiovascular diseases ; Categories ; Cholesterol ; Cigarette smoking ; Cohort Studies ; Coronary Angiography - methods ; Coronary artery ; Coronary artery disease ; Coronary Artery Disease - blood ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - ethnology ; Coronary Artery Disease - etiology ; Cross sections ; Cross-Sectional Studies ; Data processing ; Farming ; Female ; Fishing ; Forages ; Health risk assessment ; Health risks ; Heart diseases ; High density lipoprotein ; Humans ; Hunting ; Hypertension ; Inflammation ; Inflammation Mediators - blood ; Internal Medicine ; Life Style ; Lipids - blood ; Low density lipoprotein ; Male ; Middle Aged ; Physical activity ; Risk analysis ; Risk Factors ; Scanning ; Severity of Illness Index ; Smoking ; Sugar ; Tomography ; Tomography, X-Ray Computed
Is Part Of: The Lancet (British edition), 2017-04, Vol.389 (10080), p.1730-1739
Description: Summary Background Conventional coronary artery disease risk factors might potentially explain at least 90% of the attributable risk of coronary artery disease. To better understand the association between the pre-industrial lifestyle and low prevalence of coronary artery disease risk factors, we examined the Tsimane, a Bolivian population living a subsistence lifestyle of hunting, gathering, fishing, and farming with few cardiovascular risk factors, but high infectious inflammatory burden. Methods We did a cross-sectional cohort study including all individuals who self-identified as Tsimane and who were aged 40 years or older. Coronary atherosclerosis was assessed by coronary artery calcium (CAC) scoring done with non-contrast CT in Tsimane adults. We assessed the difference between the Tsimane and 6814 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). CAC scores higher than 100 were considered representative of significant atherosclerotic disease. Tsimane blood lipid and inflammatory biomarkers were obtained at the time of scanning, and in some patients, longitudinally. Findings Between July 2, 2014, and Sept 10, 2015, 705 individuals, who had data available for analysis, were included in this study. 596 (85%) of 705 Tsimane had no CAC, 89 (13%) had CAC scores of 1–100, and 20 (3%) had CAC scores higher than 100. For individuals older than age 75 years, 31 (65%) Tsimane presented with a CAC score of 0, and only four (8%) had CAC scores of 100 or more, a five-fold lower prevalence than industrialised populations (p≤0·0001 for all age categories of MESA). Mean LDL and HDL cholesterol concentrations were 2·35 mmol/L (91 mg/dL) and 1·0 mmol/L (39·5 mg/dL), respectively; obesity, hypertension, high blood sugar, and regular cigarette smoking were rare. High-sensitivity C-reactive protein was elevated beyond the clinical cutoff of 3·0 mg/dL in 360 (51%) Tsimane participants. Interpretation Despite a high infectious inflammatory burden, the Tsimane, a forager-horticulturalist population of the Bolivian Amazon with few coronary artery disease risk factors, have the lowest reported levels of coronary artery disease of any population recorded to date. These findings suggest that coronary atherosclerosis can be avoided in most people by achieving a lifetime with very low LDL, low blood pressure, low glucose, normal body-mass index, no smoking, and plenty of physical activity. The relative contributions of each are still to be determined. Funding National Institute on Aging, National Institutes of Health; St Luke's Hospital of Kansas City; and Paleocardiology Foundation.
Publisher: England: Elsevier Ltd
Language: English
Identifier: ISSN: 0140-6736
EISSN: 1474-547X
DOI: 10.1016/S0140-6736(17)30752-3
PMID: 28320601
Source: ProQuest One Psychology
MEDLINE
ProQuest Central

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Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study

Elsevier Ltd ;2017 Elsevier Ltd ;Copyright © 2017 Elsevier Ltd. All rights reserved. ;Copyright Elsevier Limited Apr 29, 2017 ;ISSN: 0140-6736 ;EISSN: 1474-547X ;DOI: 10.1016/S0140-6736(17)30752-3 ;PMID: 28320601

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