The current adult population of the Canaries presents a high prevalence of exposure to risk factors for cardiovascular disease, diabetes and cancer, among which overweight, obesity and lack of exercise stand out particularly.

High density lipoprotein cholesterol levels are linearly and significantly increased when living at a higher altitude. This fact should be taken into account when comparing cardiovascular risk in populations living at different altitudes.

CABRERA DE LEÓ N, ANTONIO, DELIA ALMEIDA GONZÁ LEZ, LINA I. PÉ REZ MÉ NDEZ, ARMANDO AGUIRRE-JAIME, MA DEL CRISTO RODRÍGUEZ PÉ REZ, SANTIAGO DOMÍNGUEZ COELLO, IRMA CARBALLO TRUJILLO. Leptin and altitude in the cardiovascular diseases. Obes Res. 2004;12:1492-1498. Objective: The lower mortality from coronary ischemic disease in populations living at high altitude has been related to an increase of high-density lipoprotein (HDL)-cholesterol at altitude. Leptin has been proposed as a cardiovascular risk factor. We investigated whether leptin varies according to the altitude at which people live. Research Methods and Procedures: This was a crosssectional study of the first 889 people enrolled in a cohort study in the Canary Islands, Spain. The relationship among serum leptin, altitude, obesity, and other cardiovascular risk factors was analyzed by bivariate and multivariate tests. Results: Leptin levels showed an inverse correlation to altitude expressed in meters (r ϭ Ϫ0.10). Obese subjects had this leptin-altitude association (r ϭ Ϫ0.19), but they also had a direct correlation of leptin to HDL-cholesterol (r ϭ 0.27) and an inverse correlation of leptin to the total cholesterol-to-HDL-cholesterol ratio (r ϭ Ϫ0.34), triglycerides (r ϭ Ϫ0.29), apolipoprotein B (r ϭ Ϫ0.21), and glycemia (r ϭ Ϫ0.19). Nonobese subjects had only the leptin-altitude association (r ϭ Ϫ0.11). The final regression model included altitude as predictor. Other associated variables were gender, physical activity, BMI, age, smoking (reducing leptin independently of BMI), alcohol, heart rate, and income.Discussion: Serum leptin level decreases when altitude increases, and this association could help to explain the lower cardiovascular mortality rate at high altitude. However, because in obese subjects there is a direct association of leptin with HDL-cholesterol and an inverse association with the lipid atherogenic fractions, we suggest the hypothesis of different roles for bound and free leptin, with free leptin being a cardiovascular protective factor in obese people.

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The high prevalence of exposure and the asociation of tobacco smoking among adolescents and their environment demands an educational program against tobacco including family, social and school environments. The agreement between declaration and serum cotinine is high only when consumption is daily.