Department of Anthropology, University of New Mexico, Albuquerque, NM, USA.
Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
Lancet. 2017 Apr 29;389(10080):1730-1739. doi: 10.1016/S0140-6736(17)30752-3. Epub 2017 Mar 17.
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.
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.
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.
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.
National Institute on Aging, National Institutes of Health; St Luke's Hospital of Kansas City; and Paleocardiology Foundation.
传统的冠心病危险因素理论可能至少能解释 90%的冠心病可归因风险。为了更好地理解前工业化生活方式与冠心病危险因素低患病率之间的关系，我们对提斯曼人进行了研究，这是一个生活在玻利维亚的狩猎采集者、渔民和农民群体，他们的心血管危险因素很少，但传染性炎症负担很高。
我们进行了一项横断面队列研究，包括所有自我认同为提斯曼人且年龄在 40 岁或以上的个体。通过对提斯曼成年人进行非对比 CT 冠状动脉钙（CAC）评分，评估冠状动脉粥样硬化情况。我们评估了提斯曼人与多民族动脉粥样硬化研究（MESA）中 6814 名参与者之间的差异。CAC 评分高于 100 被认为代表有显著的动脉粥样硬化疾病。提斯曼人的血脂和炎症生物标志物在扫描时获得，在一些患者中还进行了纵向检测。
2014 年 7 月 2 日至 2015 年 9 月 10 日期间，有 705 名数据可用于分析的个体纳入了本研究。596（85%）名提斯曼人无 CAC，89（13%）名提斯曼人 CAC 评分为 1-100，20（3%）名提斯曼人 CAC 评分高于 100。对于年龄在 75 岁以上的个体，31（65%）名提斯曼人 CAC 评分为 0，仅有 4（8%）名提斯曼人 CAC 评分为 100 或更高，这一患病率比工业化人群低五倍（所有 MESA 年龄组均 p≤0·0001）。平均 LDL 和 HDL 胆固醇浓度分别为 2.35mmol/L（91mg/dL）和 1.0mmol/L（39.5mg/dL）；肥胖、高血压、高血糖和规律吸烟较为少见。360（51%）名提斯曼人高敏 C 反应蛋白升高超过临床截断值 3.0mg/dL。
尽管存在高传染性炎症负担，但提斯曼人是玻利维亚亚马逊地区的狩猎采集者和园艺师群体，他们的冠心病危险因素很少，其冠心病患病率是迄今为止记录到的所有人群中最低的。这些发现表明，通过终生保持极低的 LDL、低血压、低血糖、正常体重指数、不吸烟和大量体力活动，大多数人可以避免冠状动脉粥样硬化。每个因素的相对贡献仍有待确定。
美国国立卫生研究院国家老龄化研究所；堪萨斯城圣卢克医院；古心脏学基金会。
