Universidad Peruana Cayetano Heredia

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

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dc.contributor.author Kaplan, Hillard
dc.contributor.author Thompson, Randall C.
dc.contributor.author Trumble, Benjamin C.
dc.contributor.author Wann, L. Samuel
dc.contributor.author Allam, Adel H.
dc.contributor.author Beheim, Bret
dc.contributor.author Frohlich, Bruno
dc.contributor.author Sutherland, M. Linda
dc.contributor.author Sutherland, James D.
dc.contributor.author Stieglitz, Jonathan
dc.contributor.author Rodriguez, Daniel Eid
dc.contributor.author Michalik, David E.
dc.contributor.author Rowan, Chris J.
dc.contributor.author Lombardi, Guido P.
dc.contributor.author Bedi, Ram
dc.contributor.author Garcia, Angela R.
dc.contributor.author Min, James K.
dc.contributor.author Narula, Jagat
dc.contributor.author Finch, Caleb E.
dc.contributor.author Gurven, Michael
dc.contributor.author Thomas, Gregory S.
dc.date.accessioned 2019-01-25T15:02:21Z
dc.date.available 2019-01-25T15:02:21Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4626
dc.description.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. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Adult en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Aged en_US
dc.subject Middle Aged en_US
dc.subject Aged, 80 and over en_US
dc.subject Risk Factors en_US
dc.subject Cross-Sectional Studies en_US
dc.subject Cohort Studies en_US
dc.subject Severity of Illness Index en_US
dc.subject Age Distribution en_US
dc.subject Life Style en_US
dc.subject Bolivia/epidemiology en_US
dc.subject Anthropometry/methods en_US
dc.subject Atherosclerosis/blood/diagnostic imaging/ethnology/etiology en_US
dc.subject Coronary Angiography/methods en_US
dc.subject Coronary Artery Disease/blood/diagnostic imaging/ethnology/etiology en_US
dc.subject Inflammation Mediators/blood en_US
dc.subject Lipids/blood en_US
dc.subject Tomography, X-Ray Computed en_US
dc.title Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S0140-6736(17)30752-3
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00
dc.relation.issn 1474-547X


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