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Effects of Living at Higher Altitudes on Mortality: A Narrative Review |
Martin Burtscher1, 2, * |
1Department of Sport Science, Medical Section, University Innsbruck, Austria 2Austrian Society for Alpine and High Altitude Medicine, Innsbruck, Austria |
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Abstract Beside genetic and life-style characteristics environmental factors may profoundly influence mortality and life expectancy. The high altitude climate comprises a set of conditions bearing the potential of modifying morbidity and mortality of approximately 400 million people who are permanently residing at elevations above 1500 meters. However, epidemiological data on the effects of high altitude living on mortality from major diseases are inconsistent probably due to differences in ethnicity, behavioral factors and the complex interactions with environmental conditions. The available data indicate that residency at higher altitudes are associated with lower mortality from cardiovascular diseases, stroke and certain types of cancer. In contrast mortality from COPD and probably also from lower respiratory tract infections is rather elevated. It may be argued that moderate altitudes are more protective than high or even very high altitudes. Whereas living at higher elevations may frequently protect from development of diseases, it could adversely affect mortality when diseases progress. Corroborating and expanding these findings would be helpful for optimization of medical care and disease management in the aging residents of higher altitudes.
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Keywords
High altitude
hypoxia
UV radiation
physical activity
disease
mortality
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Corresponding Authors:
Martin Burtscher
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Issue Date: 10 July 2014
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[1] | Finch CE, Tanzi RE(1997). Genetics of aging. Science, 278:407-411 | [2] | Latham KE, Sapienza C, Engel N(2012). The epigenetic lorax: gene-environment interactions in human health. Epigenomics, 4:383-402 | [3] | Joseph PG, Pare G, Anand SS(2013). Exploring gene-environment relationships in cardiovascular disease. Can J Cardiol, 29:37-45 | [4] | Virues-Ortega J, Hogan AM, Baya-Botti A, Kirkham FJ, Baldeweg T, Mahillo-Fernandez I(2009). Bolivian Children Living at Altitude Project (BoCLA 2006). Survival and mortality in older adults living at high altitude in Bolivia: a preliminary report. Am Geriatr Soc, 57:1955-1956 | [5] | Prabhakar NR, Semenza GL(2012). Adaptive and maladaptive cardiorespiratory responses to continuous and intermittent hypoxia mediated by hypoxia-inducible factors 1 and 2. Physiol Rev, 92:967-1003 | [6] | Faeh D, Gutzwiller F, Bopp MSwiss National Cohort Study Group2009). Lower mortality from coronary heart disease and stroke at higher altitudes in Switzerland. Circulation, 120:495-501 | [7] | Ezzati M, Horwitz ME, Thomas DS, Friedman AB, Roach R, Clark T(2012). Altitude, life expectancy and mortality from ischaemic heart disease, stroke, COPD and cancers: national population-based analysis of US counties. J Epidemiol Community Health, 66:e17 | [8] | Youk AO, Buchanich JM, Fryzek J, Cunningham M, Marsh GM(2012). An ecological study of cancer mortality rates in high altitude counties of the United States. High Alt Med Biol, 13:98-104 | [9] | Ramos DA, Kruger H, Muro M, Arias-Stella J(1967). Patologia del hombre nativo de las grandes alturas: investigacion de las causos de muerte en 300 autopsias. Bol Of Sanit Panamn, 62:497-501 | [10] | Mortimer EAJr, Monson RR, MacMahon B(1977). Reduction in mortality from coronary heart disease in men residing at high altitude. N Engl J Med, 296:581-585 | [11] | Voors AW, Johnson WD(1979). Altitude and arteriosclerotic heart disease mortality in white residents of 99 of the 100 largest cities in the United States. J Chronic Dis, 32:157-162 | [12] | Baibas N, Trichopoulou A, Voridis E, Trichopoulos D(2005). Residence in mountainous compared with lowland areas in relation to total and coronary mortality. A study in rural Greece. J Epidemiol Community Health, 59:274-278 | [13] | Winkelmayer WC, Hurley MP, Liu J, Brookhart MA(2012). Altitude and the risk of cardiovascular events in incident US dialysis patients. Nephrol Dial Transplant, 27:2411-2417 | [14] | Wozniak CJ, Baird BC, Stehlik J, Drakos SG, Bull DA, Patel AN(2012). Improved survival in heart transplant patients living at high altitude. J Thorac Cardiovasc Surg, 143:735-741 | [15] | Al-Huthi MA, Raja’a YA, Al-Noami M, Abdul Rahman AR(2006). Prevalence of coronary risk factors, clinical presentation, and complications in acute coronary syndrome patients living at high vs low altitudes in Yemen. Med Gen Med, 8:28 | [16] | León-Velarde F, Villafuerte FC, Richalet JP(2010). Chronic mountain sickness and the heart. Prog Cardiovasc Dis, 52:540-549 | [17] | Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH(2003). Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation, 107:3109-3116 | [18] | Burtscher M(2004). Endurance performance of the elderly mountaineer: requirements, limitations, testing, and training. Wien Klin Wochenschrift, 116:703-714 | [19] | Kokkinos P, Sheriff H, Kheirbek R(2011). Physical inactivity and mortality risk. Cardiol Res Pract, 2011:924945 | [20] | Burtscher M(2013). Exercise limitations by the oxygen delivery and utilization systems in aging and disease: coordinated adaptation and deadaptation of the lung-heart muscle axis - a mini-review. Gerontology, 59:289-296 | [21] | Ostadal B, Kolar F(2007). Cardiac adaptation to chronic high-altitude hypoxia: beneficial and adverse effects. Respir Physiol Neurobiol, 158:224-236 | [22] | Shohet RV, Garcia JA(2007). Keeping the engine primed: HIF factors as key regulators of cardiac metabolism and angiogenesis during ischemia. J Mol Med, 85:1309-1315 | [23] | Shrestha S, Shrestha A, Shrestha S, Bhattarai D(2012). Blood pressure in inhabitants of high altitude of Western Nepal. JNMA J Nepal Med Assoc, 52:154-158 | [24] | de Mendoza S, Nucete H, Ineichen E, Salazar E, Zerpa A, Glueck CJ(1979). Lipids and lipoproteins in subjects at 1,000 and 3,500 meter altitudes. Arch Environ Health, 34:308-311 | [25] | Sullivan JL, Bailey DM, Zacharski LR(2010). Letter by Sullivan et al regarding article, “Lower mortality from coronary heart disease and stroke at higher altitudes in Switzerland”. Circulation, 121:e376 | [26] | Cai Z, Luo W, Zhan H, Semenza GL(2013). Hypoxiainducible factor 1 is required for remote ischemic preconditioning of the heart. Proc Natl Acad Sci U S AOct7[Epub ahead of print] | [27] | Manukhina EB, Downey HF, Mallet RT(2006). Role of nitric oxide in cardiovascular adaptation to intermittent hypoxia. Exp Biol Med (Maywood)231:343-365 | [28] | Burtscher M, Bodner T, Burtscher J, Ruedl G, Kopp M, Brössner G(2013). Life-style characteristics and cardiovascular risk factors in regular downhill skiers: an observational study. BMC Public Health, 13:788 | [29] | Lo MY, Daniels JD, Levine BD, Burtscher M(2013). Sleeping altitude and sudden cardiac death. Am Heart J, 166:71-75 | [30] | Zittermann A, Gummert JF(2010). Sun, vitamin D, and cardiovascular disease. J Photochem Photobiol B, 101:124-129 | [31] | Scragg R(1981). Seasonality of cardiovascular disease mortality and the possible protective effect of ultra-violet radiation. Int J Epidemiol, 10:337-341 | [32] | Ku YC, Liu ME, Ku CS, Liu TY, Lin SL(2013). Relationship between vitamin D deficiency and cardiovascular disease. World J Cardiol, 5:337-346 | [33] | Brook RD, Franklin B, Cascio W, Hong Y, Howard G, Lipsett MPrevention Science of the American Heart Association2004). Air pollution and cardiovascular disease: a statement for healthcare professionals from the Expert Panel on Population and Prevention Science of the American Heart Association. Circulation, 109:2655-2671 | [34] | Caballero A, Torres-Duque CA, Jaramillo C, Bolívar F, Sanabria F, Osorio P(2008). Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study)Chest, 133:343-349 | [35] | Menezes AMB, Perez-Padilla R, Jardim JRB, Muiño A, Lopez MV, Valdivia G(2005). Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet, 366:1875-1881 | [36] | Laniado-Laborin R, Rendón A, Bauerle O(2011). Chronic obstructive pulmonary disease case finding in Mexico in an at-risk population. Int J Tuberc Lung Dis, 15:818-823 | [37] | Cote TR, Stroup DF, Dwyer DM, Horan JM, Peterson DE(1993). Chronic obstructive pulmonary disease mortality: a role for altitude. Chest, 103:1194-1197 | [38] | Moore LG, Rohr AL, Maisenbach JK, Reeves JT(1982). Emphysema mortality is increased in Colorado residents at high altitude. Am Rev Respir Dis, 126:225-228 | [39] | Coultas DB, Samet JM, Wiggins CL(1984). Altitude and mortality from chronic obstructive lung disease in New Mexico. Arch Environ Health, 39:355-359 | [40] | Pierson DJ(2000). Pathophysiology and clinical effects of chronic hypoxia. Respir Care, 45:39-51 | [41] | Vearrier D, Greenberg MI(2011). Occupational health of miners at altitude: adverse health effects, toxic exposures, pre-placement screening, acclimatization, and worker surveillance. Clin Toxicol (Phila)49:629-640 | [42] | Ríos-Dalenz J, Correa P, Haenszel W(1081). Morbidity from cancer in La Paz, Bolivia. Int J Cancer, 28:307-314 | [43] | Amsel J, Waterbor JW, Oler J, Rosenwaike I, Marshall K(1982). Relationship of site-specific cancer mortality rates to altitude. Carcinogenesis, 3:461-465 | [44] | Weinberg CR, Brown KG, Hoel DG(1987). Altitude, radiation, and mortality from cancer and heart disease. Radiat Res, 112:381-390 | [45] | Aceituno-Madera P, Buendía-Eisman A, Olmo FJ, Jiménez-Moleón JJ, Serrano-Ortega S(2011). [Melanoma, altitude, and UV-B radiation]. Actas Dermosifiliogr, 102:199-205 | [46] | Torres J, Correa P, Ferreccio C, Hernandez-Suarez G, Herrero R, Cavazza-Porro M(2013). Gastric cancer incidence and mortality is associated with altitude in the mountainous regions of Pacific Latin America. Cancer Causes Control, 24:249-256 | [47] | Hayes DP(2010). Cancer protection related to solar ultraviolet radiation, altitude and vitamin D. Med Hypotheses, 75(4):378-382 | [48] | Tang CM, Yu J(2013). Hypoxia-inducible factor-1 as a therapeutic target in cancer. J Gastroenterol Hepatol, 28:401-405 | [49] | Newton RU, Galvão DA(2008). Exercise in prevention and management of cancer. Curr Treat Options Oncol, 9:135-146 | [50] | Betz ME, Valley MA, Lowenstein SR, Hedegaard H, Thomas D, Stallones L(2011). Elevated suicide rates at high altitude: sociodemographic and health issues may be to blame. Suicide Life Threat Behav, 4:562-573 | [51] | Pérez-Padilla R, Franco-Marina F(2004). The impact of altitude on mortality from tuberculosis and pneumonia. Int J Tuberc Lung Dis, 8:1315-1320 | [52] | Gardiner CF, Webb GB, Ryder CT(1923). Tuberculosis Mortality in Relation to Altitude. Trans Am Climatol Clin Assoc, 39:197-208 | [53] | Niermeyer S, Andrade Mollinedo P, Huicho L(2008). Child health and living at high altitude. Arch Dis Child, 94:806-811 |
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