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

Hillard Kaplan, Randall C. Thompson, Benjamin Trumble, L. Samuel Wann, Adel H. Allam, Bret Beheim, Bruno Frohlich, M. Linda Sutherland, James D. Sutherland, Jonathan Stieglitz, Daniel Eid Rodriguez, David E. Michalik, Chris J. Rowan, Guido P. Lombardi, Ram Bedi, Angela R. Garcia, James K. Min, Jagat Narula, Caleb E. Finch, Michael GurvenGregory S. Thomas

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalThe Lancet
DOIs
StateAccepted/In press - 2017

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Coronary Artery Disease
Coronary Vessels
Cohort Studies
Cross-Sectional Studies
Calcium
Population
Life Style
Atherosclerosis
National Institute on Aging (U.S.)
Smoking
Urban Hospitals
National Institutes of Health (U.S.)
Agriculture
C-Reactive Protein
Hypotension
LDL Cholesterol
HDL Cholesterol
Blood Glucose
Body Mass Index
Obesity

ASJC Scopus subject areas

  • Medicine(all)

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Kaplan, H., Thompson, R. C., Trumble, B., Wann, L. S., Allam, A. H., Beheim, B., ... Thomas, G. S. (Accepted/In press). Coronary atherosclerosis in indigenous South American Tsimane: A cross-sectional cohort study. The Lancet. https://doi.org/10.1016/S0140-6736(17)30752-3

Coronary atherosclerosis in indigenous South American Tsimane : A cross-sectional cohort study. / Kaplan, Hillard; Thompson, Randall C.; Trumble, Benjamin; Wann, L. Samuel; Allam, Adel H.; Beheim, Bret; Frohlich, Bruno; Sutherland, M. Linda; Sutherland, James D.; Stieglitz, Jonathan; Rodriguez, Daniel Eid; Michalik, David E.; Rowan, Chris J.; Lombardi, Guido P.; Bedi, Ram; Garcia, Angela R.; Min, James K.; Narula, Jagat; Finch, Caleb E.; Gurven, Michael; Thomas, Gregory S.

In: The Lancet, 2017.

Research output: Contribution to journalArticle

Kaplan, H, Thompson, RC, Trumble, B, Wann, LS, Allam, AH, Beheim, B, Frohlich, B, Sutherland, ML, Sutherland, JD, Stieglitz, J, Rodriguez, DE, Michalik, DE, Rowan, CJ, Lombardi, GP, Bedi, R, Garcia, AR, Min, JK, Narula, J, Finch, CE, Gurven, M & Thomas, GS 2017, 'Coronary atherosclerosis in indigenous South American Tsimane: A cross-sectional cohort study', The Lancet. https://doi.org/10.1016/S0140-6736(17)30752-3
Kaplan, Hillard ; Thompson, Randall C. ; Trumble, Benjamin ; Wann, L. Samuel ; Allam, Adel H. ; Beheim, Bret ; Frohlich, Bruno ; Sutherland, M. Linda ; Sutherland, James D. ; Stieglitz, Jonathan ; Rodriguez, Daniel Eid ; Michalik, David E. ; Rowan, Chris J. ; Lombardi, Guido P. ; Bedi, Ram ; Garcia, Angela R. ; Min, James K. ; Narula, Jagat ; Finch, Caleb E. ; Gurven, Michael ; Thomas, Gregory S. / Coronary atherosclerosis in indigenous South American Tsimane : A cross-sectional cohort study. In: The Lancet. 2017.
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abstract = "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.",
author = "Hillard Kaplan and Thompson, {Randall C.} and Benjamin Trumble and Wann, {L. Samuel} and Allam, {Adel H.} and Bret Beheim and Bruno Frohlich and Sutherland, {M. Linda} and Sutherland, {James D.} and Jonathan Stieglitz and Rodriguez, {Daniel Eid} and Michalik, {David E.} and Rowan, {Chris J.} and Lombardi, {Guido P.} and Ram Bedi and Garcia, {Angela R.} and Min, {James K.} and Jagat Narula and Finch, {Caleb E.} and Michael Gurven and Thomas, {Gregory S.}",
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T1 - Coronary atherosclerosis in indigenous South American Tsimane

T2 - A cross-sectional cohort study

AU - Kaplan, Hillard

AU - Thompson, Randall C.

AU - Trumble, Benjamin

AU - Wann, L. Samuel

AU - Allam, Adel H.

AU - Beheim, Bret

AU - Frohlich, Bruno

AU - Sutherland, M. Linda

AU - Sutherland, James D.

AU - Stieglitz, Jonathan

AU - Rodriguez, Daniel Eid

AU - Michalik, David E.

AU - Rowan, Chris J.

AU - Lombardi, Guido P.

AU - Bedi, Ram

AU - Garcia, Angela R.

AU - Min, James K.

AU - Narula, Jagat

AU - Finch, Caleb E.

AU - Gurven, Michael

AU - Thomas, Gregory S.

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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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