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

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 ex... Full description

Journal Title: The Lancet (British edition) 2017, Vol.389 (10080), p.1730-1739
Main Author: Kaplan, Hillard, Prof
Other Authors: 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
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: Elsevier Ltd
ID: ISSN: 0140-6736
Link: https://www.ncbi.nlm.nih.gov/pubmed/28320601
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title: Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study
format: Article
creator:
  • 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:
  • Abridged Index Medicus
  • Adult
  • Adults
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Analysis
  • Anthropometry - methods
  • Arteriosclerosis
  • Article
  • 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
  • Coronary heart disease
  • Cross sections
  • Cross-Sectional Studies
  • Data processing
  • Farming
  • Female
  • Fishing
  • Forages
  • Health risk assessment
  • Health risks
  • Heart diseases
  • High density lipoprotein
  • Human acts
  • Human behavior
  • Human evolution
  • 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
ispartof: The Lancet (British edition), 2017, 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 Na
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleCoronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study
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creatorKaplan, 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
creatorcontribKaplan, 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
descriptionSummary 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.
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languageeng
publisherEngland: Elsevier Ltd
subjectAbridged Index Medicus ; Adult ; Adults ; Age Distribution ; Aged ; Aged, 80 and over ; Analysis ; Anthropometry - methods ; Arteriosclerosis ; Article ; 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 ; Coronary heart disease ; Cross sections ; Cross-Sectional Studies ; Data processing ; Farming ; Female ; Fishing ; Forages ; Health risk assessment ; Health risks ; Heart diseases ; High density lipoprotein ; Human acts ; Human behavior ; Human evolution ; 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
ispartofThe Lancet (British edition), 2017, Vol.389 (10080), p.1730-1739
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12Rowan, Chris J, MD
13Lombardi, Guido P, MD
14Bedi, Ram, PhD
15Garcia, Angela R, MA
16Min, James K, Prof
17Narula, Jagat, Prof
18Finch, Caleb E, Prof
19Gurven, Michael, Prof
20Thomas, Gregory S, Prof
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0Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study
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descriptionSummary 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.
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13Atherosclerosis - ethnology
14Atherosclerosis - etiology
15Biomarkers
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17Bolivia - epidemiology
18C-reactive protein
19Calcification (ectopic)
20Calcium
21Cardiovascular disease
22Cardiovascular diseases
23Categories
24Cholesterol
25Cigarette smoking
26Cohort Studies
27Coronary Angiography - methods
28Coronary artery
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30Coronary Artery Disease - blood
31Coronary Artery Disease - diagnostic imaging
32Coronary Artery Disease - ethnology
33Coronary Artery Disease - etiology
34Coronary heart disease
35Cross sections
36Cross-Sectional Studies
37Data processing
38Farming
39Female
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42Health risk assessment
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59Middle Aged
60Physical activity
61Risk analysis
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63Scanning
64Severity of Illness Index
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titleCoronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study
authorKaplan, 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
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51Hypertension
52Inflammation
53Inflammation Mediators - blood
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55Life Style
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57Low density lipoprotein
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61Risk analysis
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63Scanning
64Severity of Illness Index
65Smoking
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67Tomography
68Tomography, X-Ray Computed
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jtitleThe Lancet (British edition)
delivery
delcategoryRemote Search Resource
fulltextfulltext
addata
au
0Kaplan, Hillard, Prof
1Thompson, Randall C, Prof
2Trumble, Benjamin C, PhD
3Wann, L Samuel, MD
4Allam, Adel H, Prof
5Beheim, Bret, PhD
6Frohlich, Bruno, Prof
7Sutherland, M Linda, MD
8Sutherland, James D, MD
9Stieglitz, Jonathan, PhD
10Rodriguez, Daniel Eid, MD
11Michalik, David E, DO
12Rowan, Chris J, MD
13Lombardi, Guido P, MD
14Bedi, Ram, PhD
15Garcia, Angela R, MA
16Min, James K, Prof
17Narula, Jagat, Prof
18Finch, Caleb E, Prof
19Gurven, Michael, Prof
20Thomas, Gregory S, Prof
formatjournal
genrearticle
ristypeJOUR
atitleCoronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study
jtitleThe Lancet (British edition)
addtitleLancet
date2017
risdate2017
volume389
issue10080
spage1730
epage1739
pages1730-1739
issn0140-6736
eissn1474-547X
abstractSummary 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.
copEngland
pubElsevier Ltd
pmid28320601
doi10.1016/S0140-6736(17)30752-3
oafree_for_read