In 2008, Greg Thomas, a cardiologist from California, was in Cairo for work. While there, he visited the Egyptian Museum of Antiquities with another cardiologist, Adel Allam of Al Azhar University in Cairo. They came across the mummy of King Merneptah, a pharaoh who lived 3,200 years ago. The description on Merneptah’s case said he had suffered from atherosclerosis, the buildup of plaque on artery walls. Both men were sure this must be wrong. How could an ancient Egyptian have had heart disease, when most of the risk factors for the disease – obesity, unhealthy diet, smoking and lack of exercise – did not then exist? But could they prove it?

Thomas, a professor at the University of California, Irvine and Allam discussed how they could find out more about Merneptah’s arteries. They theorised that any arterial plaques might still be visible on a CT scan, a computerised x-ray technology that produces 3D images. Plaques contain calcium, which degrades slowly – a key reason that bones endure for so long.

After months of negotiation with officials, the pair began scanning the museum’s mummies (ironically, Merneptah was excluded, as Egyptian archaeological officials ruled that royal mummies could not be part of the project). What they found surprised them: many showed clear signs of fatty buildup in their arteries. When the results are adjusted for age (pre-modern people had shorter life-spans, so most of the remains are of people who died in their 40s or younger), the rate of atherosclerosis was about the same as it is for people in modern society, around 40%.

Until then, most researchers had believed that atherosclerosis was largely caused by modern lifestyles. The solution had seemed clear: if we moved more, ate more vegetables and fewer doughnuts, and quit smoking, we would significantly reduce the buildup of the plaques that are a key cause of heart disease.

Thomas and Allam’s results call that view into question. “The evidence that’s emerging is remarkable,” says Thomas. “These results challenge our understanding of the fundamental causes of atherosclerosis.” Since that first study, they have expanded their research, measuring plaque levels in ancient arteries all over the globe – from Egypt, Peru, Mongolia, the American southwest and the Aleutian Islands in the northern Pacific Ocean. All 14 of their “paleocardiology” studies so far have shown that atherosclerosis was common among pre-modern people.

“This work points out that we have had this problem for millennia,” says George Martin, a pathologist from the University of Washington. “So diet and lifestyle may not contribute as much as we thought. That’s a new idea.”

Caleb Finch, a biologist from the University of Southern California, who has also worked on the project, agrees. “Researchers have been confident about the causes of atherosclerosis. Our work suggests we should be less confident.” He says the results suggest that the general process of ageing has more to do with atherosclerosis than previously realised.

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