MORBIDITY AND MORTALITY FROM CARDIOVASCULAR DISEASES ACCORDING TO THE SEA-LEVEL RELATED ALTITUDE OF A REGION

It is known that the common risk factors (RF) of cardiovascular diseases (CVD) do exist and do influence all people the same. Among them are arterial hypertension, smoking, total cholesterol, obesity etc. However there are specifics of RF realization connected to climatogeographic specifics, i.e. high mountain altitudes. The review is concerned on the influence of the high altitude influence on RF of CVD. Some papers show that in high altitudes inhabitants the RF of CVD were prognostically malevolent, but the level of total and coronary mortality was lower in mountain inhabitants that can be explained by more intensive physical exertion with the background moderate hypoxia. There is an opinion that lower mortality in higher altitudes can be explained as connected with physiological adaptation to altitude and/or specifics of the climate (i.e. with UV-rays exposure, those become more intensive by 10% every 300 m). Lipidogramm are supposedly linked to moderate hypoxia and lowering of temperature, also the diet specifics might influence. However there is no stabile relation of mortality and the parameters studied. So the results collected in different trials are still controversial. But if long-term living in higher altitudes, secondarily, by the activation of adaptation capacities of the body, diet specifics and physical exertion, leads to the decrease of morbidity and mortality from CVD, short-term visiting of the mountains might be harmful for some persons and this requires individualized approach to recommendations of prevention. 

1. Baibas N, Trochopoulou A, et al. Residence in mountanous compared with lowland areas in relation to total and coronary mortality. A study in rural Greece. J Epidemiol Comm Health 2005; 59: 274-8.

2. Faeh D, Gutzwiller F, Bopp M and for the Swiss National Cohort Study Group. Lower Mortality From Coronary Heart Disease and Stroke at Higher Altitudes in Switzerland. Circulation 2009; 120: 495-501; originally published online Jul 27, 2009.

3. Bopp M and Minder ChE. Mortality by education in German speaking Switzerland, 1990–1997: results from the Swiss National Cohort. International J Epidemiol 2003; 32: 346-54.

4. Coello SD, De León AC, Ojeda FB, et al. High density lipoprotein cholesterol increases with living altitude. International J Epidemiol 2000; 29: 65-70.

5. Vaughan S, Cross S, Innes R. Coronary heart disease in highland: future impact. What we have. What we can do. Where we will be in 10-20 years time. Highland NHS Board. February 2004.

6. Allender S, Peto V, Scarborough P, et al. Coronary heart disease statistics, 2007 edition. British Heart Foundation Statistics Database, www.heartstats.org

7. Wyss ChA, Koepfli P, Fretz G, et al. Influence of Altitude Exposure on Coronary Flow Reserve. Circulation 2003; 108: 1202-7; originally published online Aug 25, 2003.

8. Alexander JK. Coronary Heart Disease at Altitude. Texas HeartInstitute J 1994; 21: 261-6.

9. Windsor JS, Van Der Kaaij J, Rodway GW, et al. Sudden Cardiac Death in an Mountain Environment. Med Sport 2009; 13(4): 197-202.

10. Küpper T. Sudden cardiac death at altitude — a multifaceted problem. Letters to the Editor. Medicina Sportiva 2010; 14 (1): 40-2.