Going High with Heart Disease: The Effect of High Altitude Exposure in Older Individuals and Patients with Coronary Artery Disease

Abstract

Levine, Benjamin D. Going high with heart disease: The effect of high altitude exposure in older individuals and patients with coronary artery disease. High Alt Med Biol 16:89-96, 2015.--Ischemic heart disease is the largest cause of death in older men and women in the western world (Lozano et al., 2012 ; Roth et al., 2015). Atherosclerosis progresses with age, and thus age is the dominant risk factor for coronary heart disease in any algorithm used to assess risk for cardiovascular events. Subclinical atherosclerosis also increases with age, providing the substrate for precipitation of acute coronary syndromes. Thus the risk of high altitude exposure in older individuals is linked closely with both subclinical and manifest coronary heart disease (CHD). There are several considerations associated with taking patients with CHD to high altitude: a) The reduced oxygen availability may cause or exacerbate symptoms; b) The hypoxia and other associated environmental conditions (exercise, dehydration, change in diet, thermal stress, emotional stress from personal danger or conflict) may precipitate acute coronary events; c) If an event occurs and the patient is far from advanced medical care, then the outcome of an acute coronary event may be poor; and d) Sudden death may occur. Physicians caring for older patients who want to sojourn to high altitude should keep in mind the following four key points: 1). Altitude may exacerbate ischemic heart disease because of both reduced O2 delivery and paradoxical vasoconstriction; 2). Adverse events, including acute coronary syndromes and sudden cardiac death, are most common in older unfit men, within the first few days of altitude exposure; 3). Ensuring optimal fitness, allowing for sufficient acclimatization (at least 5 days), and optimizing medical therapy (especially statins and aspirin) are prudent recommendations that may reduce the risk of adverse events; 4). A graded exercise test at sea level is probably sufficient for most clinical decision making and will allow for assessment of exercise capacity, and provocable ischemia. Given these considerations, most older individuals with CHD should be able to tolerate exposure to high altitude safely, and with minimal increased risk.

Cognitive and neuroimaging changes in healthy immigrants upon relocation to a high altitude: A panel study

“…Abnormalities in the anterior cingulate gyrus have been previously observed in mental disorders such as schizophrenia and depression, while decreased ReHo in the anterior cingulate gyrus has been associated with depression [Xue et al, ]. Interestingly, previous studies have reported that acute high‐altitude exposure may lead to depression and bipolar disorder as well as increase the psychological ratings for these disorders; thus, decreased ReHo in the anterior cingulate gyrus may be a neuroimaging signature for emotional changes caused by chronic high‐altitude exposure [Levine, ]. Several studies have reported that the medial frontal gyrus is associated with executive mechanisms and decision‐making abilities [Lei et al, ].…”

Effects of Hypoxia on Oxidative Stress, Autophagy and Apoptosis in Cardiomyocytes

“…Coronary heart disease (CHD) is the leading cause of death in older men and women in the western world, and reduced oxygen availability may cause or ex-acerbate symptoms of CHD [1]. A constant oxygen supply is essential for cardiac viability and function.…”

Epidemiology of Cardiac Events During Prehospital Care in Mountain Rescues Conducted in Aragón

“…Atherosclerosis gradually progresses with age, and therefore age is a predominant risk factor in coronary artery disease. 8 Hiking, the most popular physical fitness activity, 1,2,4,9,10 has benefits associated with healthy lifestyles and increased longevity. However, a lack of physical fitness, dehydration, excessive exercise intensity, and exposure to altitude can trigger adverse cardiac events in individuals with risk factors.…”