Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study
Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study
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DOI：
10.1016/s0140-6736(17)30752-3
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发表时间：
2017-04-29
期刊：
影响因子：
168.9
通讯作者：
Thomas, Gregory S.
中科院分区：
文献类型：
--
作者：
Kaplan, Hillard;Thompson, Randall C.;Thomas, Gregory S.
背景：传统的冠状动脉疾病危险因素可能潜在地解释了至少90%的冠心病归因风险。为了更好地了解工业化前的生活方式与冠状动脉疾病危险因素低患病率之间的关系，我们研究了齐曼人，这是一种玻利维亚人，过着狩猎、采集、捕鱼和耕种的勉强糊口的生活方式，心血管危险因素很少，但传染性炎症负担很高。方法我们进行了一项横断面队列研究，包括所有自认为齐曼人且年龄在40岁或以上的人。冠状动脉粥样硬化通过非增强CT冠状动脉钙化(CAC)评分来评估。我们评估了Tsimane和来自动脉粥样硬化多种族研究(MESA)的6814名参与者之间的差异。CAC评分高于100被认为是显著动脉粥样硬化性疾病的代表。在扫描时获得了细小的血脂和炎症生物标志物，在一些患者中是纵向的。2014年7月2日至2015年9月10日期间的发现，705名有数据可供分析的个体被纳入这项研究。705例Tsimane患者中，596例(85%)无CAC，89例(13%)CAC评分在1~100之间，20例(3%)CAC评分高于100。对于年龄超过75岁的人，31人(65%)的CAC得分为0，只有4人(8%)的CAC得分为100或更高，这一比例比工业化人口低5倍(MESA所有年龄段的p=0.0001)。低密度脂蛋白和高密度脂蛋白的平均浓度分别为2.35 mmoL/L(91 mg/dL)和1.0 mmoL/L(39.5 mg/dL)；肥胖、高血压、高血糖和经常吸烟的情况很少见。在360名(51%)齐曼族参与者中，超敏C反应蛋白的水平超过了临床截止值3.0 mg/dL。尽管感染炎症负担很高，齐曼族是玻利维亚亚马逊地区的园艺爱好者，几乎没有冠状动脉疾病的危险因素，但他们的冠状动脉疾病水平是有记录以来最低的。这些发现表明，在大多数人的一生中，通过非常低的低密度脂蛋白、低血压、低血糖、正常的体重指数、不吸烟和大量的体育活动可以避免冠状动脉粥样硬化。每一项的相对贡献仍有待确定。
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.