What factors should we blame most for the continuing pandemic of heart and artery disease throughout the Western world? The argument has endured more twists and turns than California Route 1. For years, the diet cholesterol hypothesis has held sway, with added blame attached to smoking and a couch potato lifestyle. Before the ascendency of the cholesterol hypothesis, cardiology favored inflammation as the main driving force for atherosclerosis, and interest in inflammation has returned thanks to studies suggesting C-reactive protein is a much better indicator of heart problems lying in wait for asymptomatic individuals than cholesterol levels or high blood pressure; a meta-analysis showing that dietary change has no impact on the risk of a heart attack; studies showing that atherogenic processes in arterial walls are driven by the immune system; and paleocardiology studies showing that pre-industrial and prehistoric societies had high levels of arterial plaque despite high exercise levels and a frugal diet low in saturated fat. i.e. that susceptibility to heart disease is not a modern phenomenon. Now, a study published last Friday in The Lancet, based on measurements taken from members of the Tsimane – a forager-horticulturalist population living in the Bolivian Amazon basin – dramatically switches the argument back again. The Tsimane have extraordinarily low rates of coronary artery disease, low blood pressure, low blood glucose, and low “bad” cholesterol (LDL), despite enduring chronic high levels of systemic inflammation due to the high pathogenic load they carry. It is infection that carries them off – not heart disease.
Further to our feature, a few weeks ago, on the state of health of the amyloid hypothesis – the dominant hypothesis to explain Alzheimer’s disease – comes news of yet another abandoned trial. This time the company is Merck and the drug under test is verubecestat, which inhibits the BACE pathway which produces the beta-amyloid protein. The trial, which has been running since 2012, was stopped because there were absolutely no signs of drug efficacy. Particularly worrying is the fact that this trial enrolled patients with mild to moderate symptoms of Alzheimer’s as opposed to previous trials which tended to target individuals with more advanced forms of the disease. Big pharma is testing the amyloid hypothesis to destruction by sticking to its core tenet that either inhibiting the production of beta-amyloid or hastening its removal from the brain is the correct route to curing Alzheimer’s and enrolling groups of individuals earlier and earlier into the disease process. In the meantime here are a couple of reflective articles published in the wake of the failed Merck trial. The first is a commentary by Derek Lowe in Science Translational Medicine and the second is an article in The Atlantic by Sarah Zhang.
There is an excellent review for the second edition of “Principles of Evolutionary Medicine”, (written by Peter Gluckman, Alan Beedle, Tatjana Buklijas, Felicia Low, and Mark Hanson), in the latest Quarterly Review of Biology. It is written by Robert Perlman of the University of Chicago. Normally, QRB lies behind a paywall, but, as luck would have it, this link to the preview page contains the whole review in a readable format, since it is all on one page.
Nominations are open now for the 2016 Omenn Prize, to be awarded at the 2017 ISEMPH Meeting in Groningen, Netherlands. The submission deadline is March 31, 2017
The International Society for Evolution, Medicine & Public Health invites nominations for the Omenn Prize of $5000 for the best article published in 2016 in any scientific journal on a topic related to evolution in the context of medicine and public health. It will be awarded in August 2017 at the ISEMPH Meeting in Groningen, Netherlands.
The prize, provided by the generosity of Gilbert S. Omenn, will be awarded to the first author of the winning article. Authors are encouraged to nominate their own articles, but nominations of articles by others are also welcome.
Nominations close March 31, 2017
Any relevant peer-reviewed article with a publication date of 2016 for the final version of the article is eligible, but the prize is intended for work that uses evolutionary principles to advance understanding of a disease or disease process. The prize committee will give priority to articles with implications for human health, but many basic science or theoretical articles have such implications.
The Prize Committee for this year is chaired by Grazyna Jasienska, and its members are James Bull and Antonis Rokas. Papers by committee members, their students and lab group members are not eligible, and articles by their co-authors or close associates are subject to special conditions. The winner will be invited to present a talk at the meeting of the International Society for Evolution and Medicine.