Medial Arterial Calcification in a 4500-Year-Old Egyptian King: A Deep-Time View of a Vascular Calcification Continuum

Abstract Background Arterial calcification is increasingly recognized as a deep-rooted biological process, observed not only in modern patients but also in ancient human remains. While atherosclerosis has been widely studied, medial arterial calcification (MAC), a distinct entity associated with chronic kidney disease (CKD), diabetes, and aging, remains largely unexplored in early populations. This gap limits our understanding of MAC’s historical prevalence and etiologic drivers. During a paleopathological investigation of a mummified forearm attributed to King Unas (Old Kingdom Egypt), we identified arterial calcifications characteristic of MAC, offering a unique opportunity to examine this pathology in a deep-time context. Methods In situ planar digital radiographs were obtained at the Egyptian Museum in Cairo using a portable system. Arterial calcifications were evaluated according to diagnostic imaging criteria. Osteometric analysis was used to estimate biological sex and stature. AMS radiocarbon dating of associated cranial fragments confirmed Old Kingdom antiquity. Results Radiographs revealed continuous, tubular, rail-track calcifications along the radial and ulnar arteries, morphologically characteristic of medial arterial calcification (MAC) and distinct from the patchy intimal calcifications of atherosclerosis. Conclusions This case represents the earliest radiographic evidence of MAC in ancient human remains and demonstrates that medial and intimal calcification predate metabolic disease contexts. In the absence of contemporary risk factors, chronic parasitic infection, particularly schistosomiasis endemic in ancient Egypt, emerges as most plausible contributor to CKD and subsequent MAC. These findings support an evolutionary framework in which MAC and IAC reflect related osteogenic pathways modulated by systemic stressors and vascular bed-specific responses. The case of King Unas thus contributes a rare deep-time data point that broadens the narrative of ancient vascular disease beyond atherosclerosis and underscores the value of integrating paleopathology with modern vascular biology to refine models of arterial calcification.