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Roman-Lazarte V, Angela Roman L, Moncada-Mapelli E, Uribe-Cavero LJ, Luz Marcelo-Armas M. Clinical manifestations and complications of preeclampsia and eclampsia in populations residing at high altitudes and very high altitudes: A scoping review. Pregnancy Hypertens 2024; 36:101119. [PMID: 38461671 DOI: 10.1016/j.preghy.2024.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Preeclampsia and eclampsia are conditions that affect gestation, characterized by high blood pressure and direct organ damage, while geographical altitude directly affects cardiovascular physiology. The aim of this review is to identify the clinical manifestations and complications of preeclampsia in pregnant women at high and very high altitudes. METHODS A scoping review was conducted to assess the objective. A systematic search was performed on Pubmed, Web of Science, Embase, Scopus, Scielo, and Lilacs. Studies including pregnant women with preeclampsia or eclampsia at high altitudes and very high altitudes were included, excluding non-citable documents. Results were summarized in tables based on bibliographic data, methodological aspects, and key findings. RESULTS Eight documents meeting the inclusion and exclusion criteria were obtained. Seven studies focused on populations in Latin America, with the highest geographical altitude being 4380 m above sea level in the city of Cerro de Pasco, Peru. One report suggests a higher admission rate to the Intensive Care Unit and a higher frequency of HELLP syndrome. Functional cardiovascular changes were also observed. CONCLUSIONS There are few studies directly evaluating pregnant populations at high altitudes and very high altitudes experiencing preeclampsia and eclampsia. Complications may be more frequent at high altitudes and very high altitudes with clinically unobservable cardiovascular changes.
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Affiliation(s)
| | - Luz Angela Roman
- Sociedad Científica de Estudiantes de Medicina Daniel Alcides Carrion, Universidad Nacional Daniel Alcides Carrion, Cerro de Pasco, Peru
| | | | - Leonardo J Uribe-Cavero
- Sociedad Científica de Estudiantes de Medicina de Ica, Facultad de Medicina Humana, Universidad Nacional San Luis Gonzaga de Ica, Ica, Perú
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André M, Brucato N, Hudjasov G, Pankratov V, Yermakovich D, Montinaro F, Kreevan R, Kariwiga J, Muke J, Boland A, Deleuze JF, Meyer V, Evans N, Cox MP, Leavesley M, Dannemann M, Org T, Metspalu M, Mondal M, Ricaut FX. Positive selection in the genomes of two Papua New Guinean populations at distinct altitude levels. Nat Commun 2024; 15:3352. [PMID: 38688933 PMCID: PMC11061283 DOI: 10.1038/s41467-024-47735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
Highlanders and lowlanders of Papua New Guinea have faced distinct environmental stress, such as hypoxia and environment-specific pathogen exposure, respectively. In this study, we explored the top genomics regions and the candidate driver SNPs for selection in these two populations using newly sequenced whole-genomes of 54 highlanders and 74 lowlanders. We identified two candidate SNPs under selection - one in highlanders, associated with red blood cell traits and another in lowlanders, which is associated with white blood cell count - both potentially influencing the heart rate of Papua New Guineans in opposite directions. We also observed four candidate driver SNPs that exhibit linkage disequilibrium with an introgressed haplotype, highlighting the need to explore the possibility of adaptive introgression within these populations. This study reveals that the signatures of positive selection in highlanders and lowlanders of Papua New Guinea align closely with the challenges they face, which are specific to their environments.
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Affiliation(s)
- Mathilde André
- Estonian Biocentre, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Nicolas Brucato
- Centre de Recherche sur la Biodiversité et l'Environnement (CRBE), Université de Toulouse, CNRS, IRD, Toulouse INP, Université Toulouse 3 - Paul Sabatier (UT3), Toulouse, France
| | - Georgi Hudjasov
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Vasili Pankratov
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Danat Yermakovich
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Francesco Montinaro
- Estonian Biocentre, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
- Department of Biosciences, Biotechnology and the Environment, University of Bari, Bari, Italy
| | - Rita Kreevan
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Jason Kariwiga
- Strand of Anthropology, Sociology and Archaeology, School of Humanities and Social Sciences, University of Papua New Guinea, University 134, PO Box 320, National Capital District, Papua New Guinea
- School of Social Science, University of Queensland, St Lucia, QLD, Australia
| | - John Muke
- Social Research Institute Ltd, Port Moresby, Papua New Guinea
| | - Anne Boland
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine (CNRGH), 91057, Evry, France
| | - Jean-François Deleuze
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine (CNRGH), 91057, Evry, France
| | - Vincent Meyer
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine (CNRGH), 91057, Evry, France
| | - Nicholas Evans
- ARC Centre of Excellence for the Dynamics of Language, Coombs Building, Fellows Road, CHL, CAP, Australian National University, Canberra, ACT, Australia
| | - Murray P Cox
- School of Natural Sciences, Massey University, Palmerston North, New Zealand
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Matthew Leavesley
- Strand of Anthropology, Sociology and Archaeology, School of Humanities and Social Sciences, University of Papua New Guinea, University 134, PO Box 320, National Capital District, Papua New Guinea
- College of Arts, Society and Education, James Cook University, P.O. Box 6811, Cairns, QLD, 4870, Australia
- ARC Centre of Excellence for Australian Biodiversity and Heritage, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Michael Dannemann
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Tõnis Org
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Mait Metspalu
- Estonian Biocentre, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Mayukh Mondal
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia.
- Institute of Clinical Molecular Biology, Christian-Albrechts-Universität zu Kiel, 24118, Kiel, Germany.
| | - François-Xavier Ricaut
- Centre de Recherche sur la Biodiversité et l'Environnement (CRBE), Université de Toulouse, CNRS, IRD, Toulouse INP, Université Toulouse 3 - Paul Sabatier (UT3), Toulouse, France.
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3
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Pooja, Sharma V, Meena RN, Ray K, Panjwani U, Varshney R, Sethy NK. TMT-Based Plasma Proteomics Reveals Dyslipidemia Among Lowlanders During Prolonged Stay at High Altitudes. Front Physiol 2021; 12:730601. [PMID: 34721061 PMCID: PMC8554329 DOI: 10.3389/fphys.2021.730601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/02/2021] [Indexed: 01/11/2023] Open
Abstract
Acute exposure to high altitude perturbs physiological parameters and induces an array of molecular changes in healthy lowlanders. However, activation of compensatory mechanisms and biological processes facilitates high altitude acclimatization. A large number of lowlanders stay at high altitude regions from weeks to months for work and professional commitments, and thus are vulnerable to altitude-associated disorders. Despite this, there is a scarcity of information for molecular changes associated with long-term stay at high altitudes. In the present study, we evaluated oxygen saturation (SpO2), heart rate (HR), and systolic and diastolic blood pressure (SBP and DBP) of lowlanders after short- (7 days, HA-D7) and long-term (3 months, HA-D150) stay at high altitudes, and used TMT-based proteomics studies to decipher plasma proteome alterations. We observed improvements in SpO2 levels after prolonged stay, while HR, SBP, and DBP remained elevated as compared with short-term stay. Plasma proteomics studies revealed higher levels of apolipoproteins APOB, APOCI, APOCIII, APOE, and APOL, and carbonic anhydrases (CA1 and CA2) during hypoxia exposure. Biological network analysis also identified profound alterations in lipoprotein-associated pathways like plasma lipoprotein assembly, VLDL clearance, chylomicron assembly, chylomicron remodeling, plasma lipoprotein clearance, and chylomicron clearance. In corroboration, lipid profiling revealed higher levels of total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL) for HA-D150 whereas high density lipoproteins (HDL) levels were lower as compared with HA-D7 and sea-level indicating dyslipidemia. We also observed higher levels of proinflammatory cytokines IL-6, TNFα, and CRP for HA-D150 along with oxidized LDL (oxLDL), suggesting vascular inflammation and proartherogenic propensity. These results demonstrate that long-term stay at high altitudes exacerbates dyslipidemia and associated disorders.
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Affiliation(s)
- Pooja
- Peptide and Proteomics Division, Defence Institute of Physiology and Allied Sciences, New Delhi, India
| | - Vandana Sharma
- Peptide and Proteomics Division, Defence Institute of Physiology and Allied Sciences, New Delhi, India
| | - Ram Niwas Meena
- Peptide and Proteomics Division, Defence Institute of Physiology and Allied Sciences, New Delhi, India
| | - Koushik Ray
- Neurophysiology Department, Defence Institute of Physiology and Allied Sciences, New Delhi, India
| | - Usha Panjwani
- Neurophysiology Department, Defence Institute of Physiology and Allied Sciences, New Delhi, India
| | - Rajeev Varshney
- Peptide and Proteomics Division, Defence Institute of Physiology and Allied Sciences, New Delhi, India
| | - Niroj Kumar Sethy
- Peptide and Proteomics Division, Defence Institute of Physiology and Allied Sciences, New Delhi, India
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Mallet RT, Burtscher J, Richalet JP, Millet GP, Burtscher M. Impact of High Altitude on Cardiovascular Health: Current Perspectives. Vasc Health Risk Manag 2021; 17:317-335. [PMID: 34135590 PMCID: PMC8197622 DOI: 10.2147/vhrm.s294121] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Globally, about 400 million people reside at terrestrial altitudes above 1500 m, and more than 100 million lowlanders visit mountainous areas above 2500 m annually. The interactions between the low barometric pressure and partial pressure of O2, climate, individual genetic, lifestyle and socio-economic factors, as well as adaptation and acclimatization processes at high elevations are extremely complex. It is challenging to decipher the effects of these myriad factors on the cardiovascular health in high altitude residents, and even more so in those ascending to high altitudes with or without preexisting diseases. This review aims to interpret epidemiological observations in high-altitude populations; present and discuss cardiovascular responses to acute and subacute high-altitude exposure in general and more specifically in people with preexisting cardiovascular diseases; the relations between cardiovascular pathologies and neurodegenerative diseases at altitude; the effects of high-altitude exercise; and the putative cardioprotective mechanisms of hypobaric hypoxia.
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Affiliation(s)
- Robert T Mallet
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Johannes Burtscher
- Department of Biomedical Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
- Institute of Sport Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
| | - Jean-Paul Richalet
- Laboratoire Hypoxie & Poumon, UMR Inserm U1272, Université Sorbonne Paris Nord 13, Bobigny Cedex, F-93017, France
| | - Gregoire P Millet
- Department of Biomedical Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
- Institute of Sport Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, A-6020, Austria
- Austrian Society for Alpine and High-Altitude Medicine, Mieming, Austria
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5
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Hill CM, Bucks RS, Cellini N, Motamedi S, Carroll A, Heathcote K, Webster R, Simpson D. Cardiac autonomic activity during sleep in high-altitude resident children compared with lowland residents. Sleep 2019; 41:5096697. [PMID: 30219885 DOI: 10.1093/sleep/zsy181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Indexed: 12/19/2022] Open
Abstract
Study Objectives We aimed to characterize heart-rate variability (HRV) during sleep in Andean children native to high altitude (HA) compared with age, gender, and genetic ancestry-similar low-altitude (LA) children. We hypothesized that the hypoxic burden of sleep at HA could induce variation in HRV. As children have otherwise healthy cardiovascular systems, such alterations could provide early markers of later cardiovascular disease. Methods Twenty-six LA (14F) and 18 HA (8F) children underwent a single night of attended polysomnography. Sleep parameters and HRV indices were measured. Linear mixed models were used to assess HRV differences across sleep stage and altitude group. Results All children showed marked fluctuations in HRV parameters across sleep stages, with higher vagal activity during nonrapid eye movement sleep and greater variability of the heart rate during rapid eye movement (REM). Moreover, HA children showed higher very low-frequency HRV in REM sleep and, after adjusting for heart rate, higher low-to-high frequency ratio in REM sleep compared with children living at lower altitude. Conclusions We confirmed previous findings of a stage-dependent modulation of HRV in Andean children living at both HA and LA. Moreover, we showed subtle alteration of HRV in sleep in HA children, with intriguing differences in the very low-frequency domain during REM sleep. Whether these differences are the results of an adaptation to high-altitude living, or an indirect effect of differences in oxyhemoglobin saturation remains unclear, and further research is required to address these questions.
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Affiliation(s)
- Catherine Mary Hill
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, UK.,Southampton Children's Hospital Department of Sleep Medicine, Southampton, UK.,School of Psychological Science, University of Western Australia, Perth, Australia
| | - Romola Starr Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Nicola Cellini
- Department of General Psychology, University of Padova, Veneto, Italy
| | - Shayan Motamedi
- Department of Mechanical Engineering, University of Southampton, UK
| | | | - Kate Heathcote
- Department of Otolaryngology, Poole General Hospital, UK
| | - Rebecca Webster
- Laboratory for Cancer Medicine, Harry Perkins Institute of Medical Research and University of Western Australia Centre for Medical Research, Perth, Australia
| | - David Simpson
- Institute of Sound and Vibration Research, University of Southampton, UK
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6
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Sleep Disordered Breathing at High Altitude in Adults and Its Interaction with Cardiovascular Homeostasis. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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7
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Bailey DM, Brugniaux JV, Filipponi T, Marley CJ, Stacey B, Soria R, Rimoldi SF, Cerny D, Rexhaj E, Pratali L, Salmòn CS, Murillo Jáuregui C, Villena M, Smirl JD, Ogoh S, Pietri S, Scherrer U, Sartori C. Exaggerated systemic oxidative-inflammatory-nitrosative stress in chronic mountain sickness is associated with cognitive decline and depression. J Physiol 2019; 597:611-629. [PMID: 30397919 PMCID: PMC6332753 DOI: 10.1113/jp276898] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/05/2018] [Indexed: 12/15/2022] Open
Abstract
KEY POINTS Chronic mountain sickness (CMS) is a maladaptation syndrome encountered at high altitude (HA) characterised by severe hypoxaemia that carries a higher risk of stroke and migraine and is associated with increased morbidity and mortality. We examined if exaggerated oxidative-inflammatory-nitrosative stress (OXINOS) and corresponding decrease in vascular nitric oxide bioavailability in patients with CMS (CMS+) is associated with impaired cerebrovascular function and adverse neurological outcome. Systemic OXINOS was markedly elevated in CMS+ compared to healthy HA (CMS-) and low-altitude controls. OXINOS was associated with blunted cerebral perfusion and vasoreactivity to hypercapnia, impaired cognition and, in CMS+, symptoms of depression. These findings are the first to suggest that a physiological continuum exists for hypoxaemia-induced systemic OXINOS in HA dwellers that when excessive is associated with accelerated cognitive decline and depression, helping identify those in need of more specialist neurological assessment and targeted support. ABSTRACT Chronic mountain sickness (CMS) is a maladaptation syndrome encountered at high altitude (HA) characterised by severe hypoxaemia that carries a higher risk of stroke and migraine and is associated with increased morbidity and mortality. The present cross-sectional study examined to what extent exaggerated systemic oxidative-inflammatory-nitrosative stress (OXINOS), defined by an increase in free radical formation and corresponding decrease in vascular nitric oxide (NO) bioavailability, is associated with impaired cerebrovascular function, accelerated cognitive decline and depression in CMS. Venous blood was obtained from healthy male lowlanders (80 m, n = 17), and age- and gender-matched HA dwellers born and bred in La Paz, Bolivia (3600 m) with (CMS+, n = 23) and without (CMS-, n = 14) CMS. We sampled blood for oxidative (electron paramagnetic resonance spectroscopy, HPLC), nitrosative (ozone-based chemiluminescence) and inflammatory (fluorescence) biomarkers. We employed transcranial Doppler ultrasound to measure cerebral blood flow (CBF) and reactivity. We utilised psychometric tests and validated questionnaires to assess cognition and depression. Highlanders exhibited elevated systemic OXINOS (P < 0.05 vs. lowlanders) that was especially exaggerated in the more hypoxaemic CMS+ patients (P < 0.05 vs. CMS-). OXINOS was associated with blunted cerebral perfusion and vasoreactivity to hypercapnia, impaired cognition and, in CMS+, symptoms of depression. Collectively, these findings are the first to suggest that a physiological continuum exists for hypoxaemia-induced OXINOS in HA dwellers that when excessive is associated with accelerated cognitive decline and depression, helping identify those in need of specialist neurological assessment and support.
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Affiliation(s)
- Damian M. Bailey
- Neurovascular Research LaboratoryFaculty of Life Sciences and Education, University of South WalesUK
| | - Julien V. Brugniaux
- Neurovascular Research LaboratoryFaculty of Life Sciences and Education, University of South WalesUK
- HP2 Laboratory, INSERM U1042Grenoble Alpes UniversityGrenobleFrance
| | - Teresa Filipponi
- Neurovascular Research LaboratoryFaculty of Life Sciences and Education, University of South WalesUK
| | - Christopher J. Marley
- Neurovascular Research LaboratoryFaculty of Life Sciences and Education, University of South WalesUK
| | - Benjamin Stacey
- Neurovascular Research LaboratoryFaculty of Life Sciences and Education, University of South WalesUK
| | - Rodrigo Soria
- Department of Cardiology and Clinical ResearchUniversity HospitalBernSwitzerland
| | - Stefano F. Rimoldi
- Department of Cardiology and Clinical ResearchUniversity HospitalBernSwitzerland
| | - David Cerny
- Department of Cardiology and Clinical ResearchUniversity HospitalBernSwitzerland
| | - Emrush Rexhaj
- Department of Cardiology and Clinical ResearchUniversity HospitalBernSwitzerland
| | | | | | | | | | - Jonathan D. Smirl
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise ScienceUniversity of British Columbia OkanaganKelownaBritish ColumbiaCanada
| | | | | | - Urs Scherrer
- Department of Cardiology and Clinical ResearchUniversity HospitalBernSwitzerland
- Facultad de Ciencias, Departamento de BiologíaUniversidad de TarapacáAricaChile
| | - Claudio Sartori
- Department of Internal MedicineUniversity HospitalUNIL‐LausanneSwitzerland
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8
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Koufakis T, Karras SN, Mustafa OG, Zebekakis P, Kotsa K. The Effects of High Altitude on Glucose Homeostasis, Metabolic Control, and Other Diabetes-Related Parameters: From Animal Studies to Real Life. High Alt Med Biol 2018; 20:1-11. [PMID: 30362832 DOI: 10.1089/ham.2018.0076] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Exposure to high altitude activates several complex and adaptive mechanisms aiming to protect human homeostasis from extreme environmental conditions, such as hypoxia and low temperatures. Short-term exposure is followed by transient hyperglycemia, mainly triggered by the activation of the sympathetic system, whereas long-term exposure results in lower plasma glucose concentrations, mediated by improved insulin sensitivity and augmented peripheral glucose disposal. An inverse relationship between altitude, diabetes, and obesity has been well documented. This is the result of genetic and physiological adaptations principally to hypoxia that favorably affect glucose metabolism; however, the contribution of financial, dietary, and other life-style parameters may also be important. According to existing evidence, people with diabetes are capable of undertaking demanding physical challenges even at extreme altitudes. Still, a number of issues should be taken into account, including the increased physical activity leading to changes in insulin demands and resistance, the performance of measurement systems under extreme weather conditions and the potential deterioration of metabolic control during climbing expeditions. The aim of this review is to present available evidence in the field in a comprehensive way, beginning from the physiology of glucose homeostasis adaptation mechanisms to high altitudes and ending to what real life experience has taught us.
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Affiliation(s)
- Theocharis Koufakis
- 1 Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital , Thessaloniki, Greece
| | - Spyridon N Karras
- 1 Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital , Thessaloniki, Greece
| | - Omar G Mustafa
- 2 Department of Diabetes, King's College Hospital , London, United Kingdom
| | - Pantelis Zebekakis
- 1 Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital , Thessaloniki, Greece
| | - Kalliopi Kotsa
- 1 Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital , Thessaloniki, Greece
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9
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Hwang J, Jang M, Kim N, Choi S, Oh YM, Seo JB. Positive association between moderate altitude and chronic lower respiratory disease mortality in United States counties. PLoS One 2018; 13:e0200557. [PMID: 29995931 PMCID: PMC6040762 DOI: 10.1371/journal.pone.0200557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
For patients with chronic lower respiratory disease, hypobaric hypoxia at a high altitude is considered a risk factor for mortality. However, the effects of residing at moderately high altitudes remain unclear. We investigated the association between moderate altitude and chronic lower respiratory disease mortality. In particular, we examined the lower 48 United States counties for age-adjusted chronic lower respiratory disease mortality rates, altitude, and socioeconomic factors, including tobacco use, per capita income, population density, sex ratio, unemployment, poverty, and education between 1979 and 1998. The socioeconomic factors were incorporated into the correlation analysis as potential covariates. Considerable positive (R = 0.235; P <0.001) and partial (R = 0.260; P <0.001) correlations were observed between altitude and chronic lower respiratory disease mortality rate. In the subgroup with high COPD prevalence subgroup, even stronger positive (R = 0.346; P <0.001) and partial (R = 0.423, P <0.001) correlations were observed. Multivariate regression analysis of all available socioeconomic factors revealed that additional knowledge on altitude improved the adjusted R2 values from 0.128 to 0.186 for all counties and from 0.301 to 0.421 for counties with high COPD prevalence. We concluded that in the lower 48 United States counties, even a moderate altitude may pose considerable risks in patients with chronic lower respiratory disease.
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Affiliation(s)
- Jeongeun Hwang
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Miso Jang
- Department of Family Medicine and Center for Cancer Prevention and Detection, Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seunghyun Choi
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yeon-Mok Oh
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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10
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Hill CM, Baya A, Gavlak J, Carroll A, Heathcote K, Dimitriou D, L'Esperance V, Webster R, Holloway J, Virues-Ortega J, Kirkham FJ, Bucks RS, Hogan AM. Adaptation to Life in the High Andes: Nocturnal Oxyhemoglobin Saturation in Early Development. Sleep 2016; 39:1001-8. [PMID: 26951394 DOI: 10.5665/sleep.5740] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/22/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Physiological adaptation to high altitude hypoxia may be impaired in Andeans with significant European ancestry. The respiratory 'burden' of sleep may challenge adaptation, leading to relative nocturnal hypoxia. Developmental aspects of sleep-related breathing in high-altitude native children have not previously been reported. We aimed to determine the influence of development on diurnal-nocturnal oxyhemoglobin differences in children living at high altitude. METHODS This was a cross-sectional, observational study. Seventy-five healthy Bolivian children aged 6 mo to 17 y, native to low altitude (500 m), moderate high altitude (2,500 m), and high altitude (3,700 m) were recruited. Daytime resting pulse oximetry was compared to overnight recordings using Masimo radical oximeters. Genetic ancestry was determined from DNA samples. RESULTS Children had mixed European/Amerindian ancestry, with no significant differences between altitudes. Sixty-two participants had ≥ 5 h of nocturnal, artifact-free data. As predicted, diurnal mean oxyhemoglobin saturation decreased across altitudes (infants and children, both P < 0.001), with lowest diurnal values at high altitude in infants. At high altitude, there was a greater drop in nocturnal mean oxyhemoglobin saturation (infants, P < 0.001; children, P = 0.039) and an increase in variability (all P ≤ 0.001) compared to low altitude. Importantly, diurnal to nocturnal altitude differences diminished (P = 0.036), from infancy to childhood, with no further change during adolescence. CONCLUSIONS Physiological adaptation to high-altitude living in native Andeans is unlikely to compensate for the significant differences we observed between diurnal and nocturnal oxyhemoglobin saturation, most marked in infancy. This vulnerability to sleep-related hypoxia in early childhood has potential lifespan implications. Future studies should characterize the sleep- related respiratory physiology underpinning our observations.
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Affiliation(s)
- Catherine Mary Hill
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, UK.,Southampton Children's Hospital, Southampton, UK
| | - Ana Baya
- Department of Psychology, Universidad Privada de Santa Cruz de la Sierra, Santa Cruz - Bolivia
| | - Johanna Gavlak
- Southampton Children's Hospital, Southampton, UK.,Neurosciences Unit, UCL Institute of Child Health, UK
| | | | - Kate Heathcote
- Department of Otolaryngology, Poole General Hospital, UK
| | | | - Veline L'Esperance
- Department of Primary Care and Population Health, Kings College London, UK
| | - Rebecca Webster
- Laboratory for Cancer Medicine, Harry Perkins Institute of Medical Research and University of Western Australia Centre for Medical Research, Perth, Australia
| | - John Holloway
- Division of Human Development and Health. Faculty of Medicine, University of Southampton, UK
| | - Javier Virues-Ortega
- School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Fenella Jane Kirkham
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, UK.,Southampton Children's Hospital, Southampton, UK.,Neurosciences Unit, UCL Institute of Child Health, UK
| | | | - Alexandra Marie Hogan
- Cognitive Neuroscience & Psychiatry, UCL Institute of Child Health, UK.,North Central London School of Anaesthesia, London, UK
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11
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Faramoushi M, Amir Sasan R, Sari Sarraf V, Karimi P. Cardiac fibrosis and down regulation of GLUT4 in experimental diabetic cardiomyopathy are ameliorated by chronic exposures to intermittent altitude. J Cardiovasc Thorac Res 2016; 8:26-33. [PMID: 27069564 PMCID: PMC4827136 DOI: 10.15171/jcvtr.2016.05] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/03/2016] [Indexed: 12/15/2022] Open
Abstract
Introduction: Chronic intermittent hypoxia is considered as a preconditioning status in cardiovascular health to inducing resistance to the low oxygen supply. Diabetic cardiomyopathy leads to inability of the heart to effective circulation of blood preventing of consequent tissue damages so; the aim of this study was elucidation of effect of chronic exposure to hypoxia on Cardiac fibrosis and expression of GLUT4 in experimental diabetic cardiomyopathy.
Methods: A total number of 30 rats were randomly divided into three groups; 1: Normoxia control group (NN, n = 10). 2: Normoxia diabetic group (ND, n = 10) that took fat diet for 2 weeks then were injected by streptozotocin (37 mg/kg) and 3: Hypoxia diabetic group (HD, n = 10): that were exposed to chronic intermittent hypoxia (CIH) (altitude ≈3400 m, 14% oxygen for 8 weeks). After hypoxia challenge, plasma metabolic parameters including: fasting blood glucose (FBS), triglyceride (TG) and total cholesterol (TC) were measured by colorimetric assay. Cardiac expression of GLUT4 protein and cardiac collagen accumulation were determined in the excised left ventricle by western blotting, and Masson trichrome staining respectively.
Results: Based on resultant data, FBS, TG and TC were significantly (P < 0.05) decreased in HD vs. ND. Homeostasis Model Assessment (HOMA) were also significantly attenuated after exposed to CIH in HD group compared to ND group (P < 0.05). Significant increase in packed cell volume and hemoglobin concentration was observed in HD group compared to ND group (P < 0.05). Comparison of heart wet weight between three groups showed a significant difference (P < 0.05) with lower amount in HD and ND versus NN. Myocardial fibrosis was significantly more pronounced in ND when compared to NN. Eight weeks exposure to hypoxia ameliorated this increase in HD group. Intermittent hypoxia significantly increased GLUT4 protein expression in HD compared to ND group (P < 0.05).
Conclusion: Data suggested that CIH might potentiate to improve glucose homeostasis and cardiac tissue structural damages created in type 2 diabetes (T2D).
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Affiliation(s)
- Mahdi Faramoushi
- Department of Physical Education and Sport, Tabriz Islamic Art University, Tabriz, Iran
| | - Ramin Amir Sasan
- Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Vahid Sari Sarraf
- Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Pouran Karimi
- Neuroscience Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
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12
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Burtscher M. Effects of living at higher altitudes on mortality: a narrative review. Aging Dis 2014; 5:274-80. [PMID: 25110611 PMCID: PMC4113517 DOI: 10.14336/ad.2014.0500274] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 01/21/2023] Open
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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Affiliation(s)
- Martin Burtscher
- Department of Sport Science, Medical Section, University Innsbruck, Austria
- Austrian Society for Alpine and High Altitude Medicine, Innsbruck, Austria
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13
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Qian G, Ran X, Zhou CX, Deng DQ, Zhang PL, Guo Y, Luo JH, Zhou XH, Xie H, Cai M. Systemic lupus erythematosus patients in the low-latitude plateau of China: altitudinal influences. Lupus 2014; 23:1537-45. [PMID: 25059490 DOI: 10.1177/0961203314544186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The current study was to investigate the features of hospitalized patients with systemic lupus erythematosus (SLE) at different altitudes. The correlation between SLE activity and altitudinal variations was also explored. Medical records of 1029 patients were retrospectively reviewed. Activity of SLE in each organ system was recorded using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). There was no significant correlation between SLE activity and altitudes (r = 0.003, p = 0.159). Age at onset for SLE patients at high altitudes was significantly younger than that at low and moderate altitudes (p = 0.022 and p = 0.004, respectively). Age at SLE admission at low altitudes was significant older than those at moderate and high altitudes (p = 0.011 and p < 0.001, respectively). Patients at high altitudes had shorter duration from disease onset to admission than those at moderate altitudes (p = 0.009). Incidence of Sm antibodies-positive for resident patients at high altitudes was 36.4%, which were higher than that at moderate altitudes (p = 0.003). We found increasing trends of CNS activity in active patients; immunological and renal activities in inactive patients were correlated with elevated altitudes (p = 0.024, p = 0.004, p = 0.005), while arthritis scores in active patients showed the tendency of decreasing with the rise of elevation (p = 0.002). Hemoglobin level, red blood cell and platelet counts at high altitudes were significantly lower than those at low altitudes (p < 0.05, respectively). There was no significant difference in hemoglobin level between moderate- and low-altitude groups (p > 0.05). No significant difference in platelet counts between moderate- and high-altitude groups was observed (p > 0.05). Our findings suggest that some clinical features, laboratory tests and activity of main organs in SLE are influenced by altitudes. Furthermore, organ activities of active and inactive SLE patients have different patterns of altitudinal variations. These distinctive variations likely reveal that peculiar environmental factors at high altitudes can affect the development of SLE.
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Affiliation(s)
- G Qian
- Department of Dermatology & Rheumatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - X Ran
- Department of Dermatology & Rheumatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - C X Zhou
- Department of Dermatology & Rheumatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - D Q Deng
- Department of Dermatology & Rheumatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - P L Zhang
- Department of Dermatology & Rheumatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Y Guo
- Department of Dermatology & Rheumatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - J H Luo
- Department of Epidemiology, School of Public Health, Kunming Medical University, Kunming, China
| | - X H Zhou
- Department of Dermatology & Rheumatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - H Xie
- Department of Dermatology & Rheumatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - M Cai
- Department of Dermatology & Rheumatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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14
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Sherpa LY, Deji, Stigum H, Chongsuvivatwong V, Nafstad P, Bjertness E. Prevalence of metabolic syndrome and common metabolic components in high altitude farmers and herdsmen at 3700 m in Tibet. High Alt Med Biol 2013; 14:37-44. [PMID: 23537259 DOI: 10.1089/ham.2012.1051] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To estimate the prevalence of metabolic syndrome, its associated factors and components in 30-80-year-old Tibetans living at high altitude. METHOD Multistage sampling of 692 participants. We used IDF criteria for estimation of the metabolic syndrome, and a questionnaire based on the WHO MONICA protocol. RESULTS The prevalence of metabolic syndrome was 8.2% (Confidence interval (CI):6.1-10.2) while the common components were: fasting hyperglycemia 57.5% (53.8-61.1); abdominal obesity 46% (42.2-49.7); and high blood pressure 37% (33.4-40.5). Metabolic syndrome was significantly lower for males, those with higher education and physical activity >2000 Kcal/week. Self awareness, treatment and control were low for both diabetes and lipid abnormality. CONCLUSION The overall prevalence of metabolic syndrome in high altitude farmers and herdsmen in Tibet was lower compared to other high altitude natives, while its components (hyperglycemia, obesity, and high blood pressure) were higher than in other high altitude communities. Implications of the findings of high prevalence of smoking (among men), obesity, and hypertension and low rates of awareness, treatment, and control of the components of the metabolic syndrome among rural highlanders propels the need for health programs targeting risk factors.
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Affiliation(s)
- Lhamo Y Sherpa
- Section for Preventive Medicine and Epidemiology, Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
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15
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Virués-Ortega J, Bucks R, Kirkham FJ, Baldeweg T, Baya-Botti A, Hogan AM. Changing patterns of neuropsychological functioning in children living at high altitude above and below 4000 m: a report from the Bolivian Children Living at Altitude (BoCLA) study. Dev Sci 2011; 14:1185-93. [PMID: 21884333 DOI: 10.1111/j.1467-7687.2011.01064.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The brain is highly sensitive to environmental hypoxia. Little is known, however, about the neuropsychological effects of high altitude residence in the developing brain. We recently described only minor changes in processing speed in native Bolivian children and adolescents living at approximately 3700 m. However, evidence for loss of cerebral autoregulation above this altitude (4000 m) suggests a potential threshold of hypoxia severity over which neuropsychological functioning may be compromised. We conducted physiological and neuropsychological assessments in 62 Bolivian children and adolescents living at La Paz (∼3700 m) and El Alto (∼4100 m) in order to address this issue. Groups were equivalent in terms of age, gender, social class, schooling, parental education and genetic admixture. Apart from percentage of hemoglobin saturated with oxygen in arterial blood (%SpO(2)), participants did not differ in their basal cardiac and cerebrovascular performance as explored by heart rate, mean arterial pressure, end-tidal carbon dioxide, and cerebral blood flow velocity at the basilar, anterior, middle and posterior cerebral arteries. A comprehensive neuropsychological assessment was administered, including tests of executive functions, attention, memory and psychomotor performance. Participants living at extreme altitude showed lower levels of performance in all executive tests (Cohen effect size = -0.91), whereas all other domains remained unaffected by altitude of residence. These results are compatible with earlier physiological evidence of a transitional zone for cerebral autoregulation at an altitude of 4000 m. We now show that above this threshold, the developing brain is apparently increasingly vulnerable to neuropsychological deficit.
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