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Figure 1.  Adult Inuit Mummified Individual Who Was Scanned With Computed Tomography
Adult Inuit Mummified Individual Who Was Scanned With Computed Tomography

Courtesy of the Peabody Museum of Archaeology and Ethnology, Harvard University, PM 29-10-10/61570.0. This Figure should not be reproduced without permission of the Peabody Museum of Archaeology and Ethnology at Harvard University. Requests should be sent to pmimages@fas.harvard.edu.

Figure 2.  Computed Tomography Images Showing Calcified Atherosclerotic Plaques
Computed Tomography Images Showing Calcified Atherosclerotic Plaques

Arrows indicate calcified atherosclerotic plaques.

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(9873):1211-1222. doi:10.1016/S0140-6736(13)60598-XPubMedGoogle ScholarCrossref
2.
Zimmerman  MR, Yeatman  GW, Sprinz  H, Titterington  WP.  Examination of an Aleutian mummy.  Bull N Y Acad Med. 1971;47(1):80-103.PubMedGoogle Scholar
3.
Bang  HO, Dyerberg  J, Nielsen  AB.  Plasma lipid and lipoprotein pattern in Greenlandic West-coast Eskimos.  Lancet. 1971;1(7710):1143-1145. doi:10.1016/S0140-6736(71)91658-8PubMedGoogle ScholarCrossref
4.
Davis  HR, Bridenstine  RT, Vesselinovitch  D, Wissler  RW.  Fish oil inhibits development of atherosclerosis in rhesus monkeys.  Arteriosclerosis. 1987;7(5):441-449. doi:10.1161/01.ATV.7.5.441PubMedGoogle ScholarCrossref
5.
Bhatt  DL, Steg  PG, Miller  M,  et al; REDUCE-IT Investigators.  Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia.  N Engl J Med. 2019;380(1):11-22. doi:10.1056/NEJMoa1812792PubMedGoogle ScholarCrossref
6.
Hooten  EA.  Lapps, Eskimos, and Martin Luther.  Harvard Alumni Bulletin. 1930;32(19):545-553.Google Scholar
7.
Allam  AH, Mandour Ali  MA, Wann  LS,  et al.  Atherosclerosis in ancient and modern Egyptians: the Horus study.  Glob Heart. 2014;9(2):197-202. doi:10.1016/j.gheart.2014.03.2454PubMedGoogle ScholarCrossref
8.
Kaplan  H, Thompson  RC, Trumble  BC,  et al.  Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study.  Lancet. 2017;389(10080):1730-1739. doi:10.1016/S0140-6736(17)30752-3PubMedGoogle ScholarCrossref
9.
Wann  LS, Lombardi  G, Ojeda  B,  et al.  The Tres Ventanas Mummies of Peru.  Anat Rec (Hoboken). 2015;298(6):1026-1035. doi:10.1002/ar.23137PubMedGoogle ScholarCrossref
10.
Rajagopalan  S, Al-Kindi  SG, Brook  RD.  Air pollution and cardiovascular disease: JACC State-of-the-Art review.  J Am Coll Cardiol. 2018;72(17):2054-2070. doi:10.1016/j.jacc.2018.07.099PubMedGoogle ScholarCrossref
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    1 Comment for this article
    Omnivore diet explains findings
    Ulrich Bartels, State Exam med Göttingen, FRCOG | Mayo University Hospital
    This study confirms that a diet rich in animal protein and fat has detrimental effect on cardiovascular disease. The study confirms that their diet was composed of many mammals, birds and fish. Unfortunately the omega 3 contained in fish is of EPA and DHA whereas the ALA from plant sources appears to be the protective component (as far as cardio-vascular health is concerned). This would explain their arteriosclerosis.

    CONFLICT OF INTEREST: None Reported
    Research Letter
    Cardiology
    December 27, 2019

    Atherosclerosis in 16th-Century Greenlandic Inuit Mummies

    Author Affiliations
    • 1Ascension Healthcare, Milwaukee, Wisconsin
    • 2Icahn School of Medicine at Mount Sinai, New York, New York
    • 3Brigham and Women’s Hospital, Boston, Massachusetts
    • 4St Luke’s Mid-America Heart Institute, Kansas City, Missouri
    • 5Smithsonian Institution, Washington, DC
    • 6University of Southern California, Los Angeles
    • 7Memorial Care Heart & Vascular Institute, Fountain Valley, California
    JAMA Netw Open. 2019;2(12):e1918270. doi:10.1001/jamanetworkopen.2019.18270
    Introduction

    Atherosclerosis is often thought of as unique to modern Homo sapiens, the product of our contemporary diet, lifestyle, and environment superimposed on primordial susceptibility. However, the HORUS Study Group has found that atherosclerosis existed at least as far back as 4000 bce.1 Arterial calcification has been found in 34 of 137 mummified remains from 3 continents across wide variations in lifestyle and heritage, including in hunter-gatherer populations.1,2 None of these individuals consumed a primarily marine-based diet rich in ω-3 fatty acids. Fifty years ago, Danish researchers3 hypothesized that high intake of marine animals rich in fish oil containing ω-3 fatty acids protected native Greenlandic Inuit peoples from atherosclerosis. Davis and colleagues4 found fish oil reduced the atherosclerosis induced in rhesus monkeys exposed to a high-cholesterol atherogenic diet. In 2019,5 interest persists in the actions of ω-3 fatty acids in their natural and highly purified forms. To better understand the early history of human atherosclerosis, we performed a case series study of Inuit hunter-gatherer people living 500 years ago who consumed a marine-based diet.

    Methods

    Five Inuit mummies curated at the Peabody Museum of Archaeology and Ethnology, Cambridge, Massachusetts, were studied at the Heart and Vascular Center of the Brigham and Women’s Hospital, Boston, Massachusetts. Permission to perform imaging was granted by the Peabody Museum of Archaeology and Ethnology. These natural mummies, preserved primarily by the cold environment, were discovered by Martin Luther on the Greenlandic island of Uunartaq, Greenland, in 1929.6 Grave goods and typical clothing indicated burial in the 1500s, when these individuals would have lived in stone, whale bone, and seal skin huts and hunted from kayaks with spears, bows, and arrows for their diet of fish, birds, marine mammals, and caribou.

    Multidetector whole-body computed tomography (CT) images were obtained at 80 and 120 kV with 6-mm slice thickness with 50% overlap and reconstructed using multiple kernels with a third-generation dual-source CT scanner (Siemens). Images were reviewed and interpreted by consensus of 5 cardiologists (L.S.W., J.N., R.B., R.C.T., and G.S.T.) and 2 radiologists with extensive experience interpreting mummy CT images. Age and sex were estimated from bone and dental development by a physical anthropologist (B.F.).

    Results

    An infant mummy was excluded from further analysis owing to paucity of non–bony tissue. Based on skeletal and dental features, the remaining mummies were adolescents or young adults, including 2 men who died at ages 18 to 22 years and 25 to 30 years and 2 women who died at ages 16 to 18 years and 25 to 30 years (Figure 1). The causes of death could not be determined. Remnants of the carotid arteries, the thoracic and retroperitoneal aorta, and iliac arteries were preserved in all 4 individuals, but reliable anatomic landmarks within the heart could not be identified. Three mummies had evidence of calcified atheroma, identified as discrete high-density regions in an arterial distribution (Figure 2). Incomplete visualization of the arterial vascular tree precluded accurate grading of the magnitude or severity of vascular calculation and evaluation of clinical disease. Nevertheless, the appearance of vascular calcification in these 3 mummies resembled previous observations of atherosclerosis in mummies and living humans.

    Discussion

    This case series presents evidence for the presence of calcified plaques in the mummified remains of 3 young Inuit individuals living 500 years ago, suggesting the presence of atherosclerosis despite their vigorous lifestyle and marine-based diet. While we cannot know the incidence of ancient ischemic events, cardiovascular deaths were rare among mid-20th century Inuit people, similar to contemporary Amazonian Tsimane people, who have low-grade atherosclerosis and low incidence of cardiovascular death.7-9 The etiologic complexity of atherosclerosis confounds identification of single factors, such as ω-3 fatty acids, as causal or protective. Other factors may include environmental smoke,10 which is produced by indoor fires used by Inuit and many other ancient peoples who also incurred atherosclerosis.

    Back to top
    Article Information

    Accepted for Publication: October 2, 2019.

    Published: December 27, 2019. doi:10.1001/jamanetworkopen.2019.18270

    Correction: This article was corrected on January 22, 2020, to fix an omission in the caption of Figure 1.

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Wann LS et al. JAMA Network Open.

    Corresponding Author: L. Samuel Wann, MD, Ascension Healthcare, 4175 N Oakland Ave, Milwaukee, WI 53211 (samuelwann@gmail.com).

    Author Contributions: Dr Wann had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Wann, Thompson, Finch, Thomas.

    Acquisition, analysis, or interpretation of data: Wann, Narula, Blankstein, Thompson, Frohlich, Thomas.

    Drafting of the manuscript: Wann, Thompson, Frohlich, Thomas.

    Critical revision of the manuscript for important intellectual content: Wann, Narula, Blankstein, Thompson, Finch, Thomas.

    Statistical analysis: Wann, Frohlich.

    Obtained funding: Frohlich.

    Administrative, technical, or material support: Wann, Blankstein, Thompson, Frohlich, Thomas.

    Supervision: Wann.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: The Paleocardiology Foundation, a nonprofit charity unrelated to industry, provided funds to transport the mummies from the Peabody Museum to Brigham and Women’s Hospital, where computed tomography scanning was performed without charge.

    Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Additional Contributions: All authors are members of the Horus Study Group. Other Horus Study Group members who participated in the study design and data analysis included Adel H. Allam, MD (Al-Azar University); Guido P. Lombardi, MD, MS (Universidad Peruana Cayetano Heredia); Crystal Medina, MD, MPH, and David E. Michalik, DO (University of California, Irvine); Michael I. Miyamoto, MD (Providence St. Joseph Health); Christopher J. Rowan, MD (Renown Hospital Nevada); M. Linda Sutherland, MD, and James D. Sutherland, MD, MS (Memorial Care Heart & Vascular Institute); Michael L. Steigner MD (Brigham and Women’s Hospital); Emily M. Venable, AB (Harvard University); and Albert R. Zink, PhD (Eurac Research). They were not compensated for their contributions.

    References
    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(9873):1211-1222. doi:10.1016/S0140-6736(13)60598-XPubMedGoogle ScholarCrossref
    2.
    Zimmerman  MR, Yeatman  GW, Sprinz  H, Titterington  WP.  Examination of an Aleutian mummy.  Bull N Y Acad Med. 1971;47(1):80-103.PubMedGoogle Scholar
    3.
    Bang  HO, Dyerberg  J, Nielsen  AB.  Plasma lipid and lipoprotein pattern in Greenlandic West-coast Eskimos.  Lancet. 1971;1(7710):1143-1145. doi:10.1016/S0140-6736(71)91658-8PubMedGoogle ScholarCrossref
    4.
    Davis  HR, Bridenstine  RT, Vesselinovitch  D, Wissler  RW.  Fish oil inhibits development of atherosclerosis in rhesus monkeys.  Arteriosclerosis. 1987;7(5):441-449. doi:10.1161/01.ATV.7.5.441PubMedGoogle ScholarCrossref
    5.
    Bhatt  DL, Steg  PG, Miller  M,  et al; REDUCE-IT Investigators.  Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia.  N Engl J Med. 2019;380(1):11-22. doi:10.1056/NEJMoa1812792PubMedGoogle ScholarCrossref
    6.
    Hooten  EA.  Lapps, Eskimos, and Martin Luther.  Harvard Alumni Bulletin. 1930;32(19):545-553.Google Scholar
    7.
    Allam  AH, Mandour Ali  MA, Wann  LS,  et al.  Atherosclerosis in ancient and modern Egyptians: the Horus study.  Glob Heart. 2014;9(2):197-202. doi:10.1016/j.gheart.2014.03.2454PubMedGoogle ScholarCrossref
    8.
    Kaplan  H, Thompson  RC, Trumble  BC,  et al.  Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study.  Lancet. 2017;389(10080):1730-1739. doi:10.1016/S0140-6736(17)30752-3PubMedGoogle ScholarCrossref
    9.
    Wann  LS, Lombardi  G, Ojeda  B,  et al.  The Tres Ventanas Mummies of Peru.  Anat Rec (Hoboken). 2015;298(6):1026-1035. doi:10.1002/ar.23137PubMedGoogle ScholarCrossref
    10.
    Rajagopalan  S, Al-Kindi  SG, Brook  RD.  Air pollution and cardiovascular disease: JACC State-of-the-Art review.  J Am Coll Cardiol. 2018;72(17):2054-2070. doi:10.1016/j.jacc.2018.07.099PubMedGoogle ScholarCrossref
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