Increased Cardiometabolic Risk and Worsening Hypoxemia at High Altitude

Miele, Catherine H.; Schwartz, Alan R.; Gilman, Robert H.; Pham, Luu V.; Wise, Robert A.; Dávila‐Román, Víctor G.; Jun, Jonathan C.; Polotsky, Vsevolod Y.; Miranda, J. Jaime; León‐Velarde, Fabiola

doi:10.1089/ham.2015.0084

Cited by 46 publications

(42 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings suggest that the frequency of events rather than severity of nocturnal hypoxemia could account for glucose intolerance in these highlanders. In addition to recurrent SDB episodes, we confirmed our previous finding that sustained hypoxemia during wakefulness was also associated with HbA1c elevations [27] ( see Fig. 4, left column ).…”

Section: Discussionsupporting

confidence: 90%

“…Recently, we have found unique associations between cardiometabolic outcomes, sleep-related breathing disturbances [26] and hypoxemia during wakefulness in Peruvian highlanders [27], suggesting a pathogenic role for SDB. We hypothesized that chronic and intermittent nocturnal hypoxemia are differentially associated with specific biomarkers of cardiometabolic dysfunction, viz., hemoglobin concentration and glucose levels, respectively.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Cardiometabolic correlates of sleep disordered breathing in Andean highlanders

et al. 2017

Self Cite

View full text Add to dashboard Cite

Associations between sleep disordered breathing (SDB) and cardiometabolic outcomes have not been examined in highlanders. We performed nocturnal polygraphy in Peruvian highlanders (3825m). Multi-variable linear regression models examined associations between SDB metrics and hemoglobin, glucose tolerance (hemoglobin A1c (HbA1c), fasting glucose and homeostatic model assessment of β-cell function (HOMA-β) and insulin resistance (HOMA-IR)), blood pressure and lipids, while adjusting for age, sex, body-mass index (BMI) and wake oxygenation. Participants (n=187, 91 men) were 52 years-old (IQR 45–62), had BMI of 27.0 kg/m2 (24.3–29.5) and 87% (85–88) oxyhemoglobin saturation during wakefulness. In fully adjusted models, worsening nocturnal hypoxemia was associated with hemoglobin elevations in men (p=0.03), independent of wake oxygenation and apnea-hypopnea index (AHI); whereas worsening wake oxygenation was associated with hemoglobin elevations in older women (p=0.02). In contrast, AHI was independently associated with HbA1c elevations (p<0.05). In single-variable models, nocturnal hypoxemia was associated with higher HbA1c, HOMA-IR and HOMA-β (p<0.001, =0.02 and =0.04); whereas AHI was associated with HOMA-IR, systolic blood pressure and triglyceride elevations (p=0.02, =0.01, and <0.01). These associations were not significant in fully adjusted models. In highlanders, nocturnal hypoxemia and sleep apnea were associated with distinct cardiometabolic outcomes, conferring differential risk for excessive erythrocytosis and glucose intolerance, respectively.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Cardiometabolic correlates of sleep disordered breathing in Andean highlanders

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…The most recent reports on long-term high-altitude residents have shown increases in cardiometabolic risks (metabolic syndrome), where a higher BMI is associated with lower oxygen saturation [61]. In concordance with this, it has also been demonstrated that a strong association exists between being overweight or having metabolic syndrome and excessive erythrocytosis (CMS) [62].…”

Section: Obesity and Chronic Exposure To High Altitudementioning

confidence: 86%

“…Although it seems clear that obesity and overweight, according to current knowledge, exert their most deleterious effects by aggravating hypoxemia at high altitude, thereby triggering the development of high altitude illnesses [5,61], it is thus far not known how adipose tissue function and severe high-altitude hypoxemia interact. Further studies are required to further investigate this interaction.…”

Section: Hypoxia and Adipose Tissuementioning

confidence: 99%

Obesity as a Conditioning Factor for High-Altitude Diseases

et al. 2017

View full text Add to dashboard Cite

Obesity, a worldwide epidemic, has become a major health burden because it is usually accompanied by an increased risk for insulin resistance, diabetes, hypertension, cardiovascular diseases, and even some kinds of cancer. It also results in associated increases in healthcare expenditures and labor and economic consequences. There are also other fields of medicine and biology where obesity or being overweight play a major role, such as high-altitude illnesses (acute mountain sickness, hypoxic pulmonary hypertension, and chronic mountain sickness), where an increasing relationship among these two morbid statuses has been demonstrated. This association could be rooted in the interactions between obesity-related metabolic alterations and critical ventilation impairments due to obesity, which would aggravate hypobaric hypoxia at high altitudes, leading to hypoxemia, which is a trigger for developing high-altitude diseases. This review examines the current literature to support the idea that obesity or overweight could be major conditioning factors at high altitude.

show abstract

“…In terms of the offspring, one of the outcomes of pre-eclampsia is a restriction of fetal growth, characterized by already well described long term consequences for increased risk of non-communicable diseases, including cardiovascular and metabolic conditions [70–72]. Adding to the complexity offered by low- and middle-income settings, the observed pathophysiologic changes will be compounded with, and will require broader expansions to explicitly assess the human-environment interactions, particularly cardiovascular and metabolic adaptations to high-altitude settings [73–77]. …”

Section: Challenges For Global Health Cardiologymentioning

confidence: 99%

Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors

Mendoza¹,

Miranda

2017

Cardiology Clinics

Self Cite

View full text Add to dashboard Cite

One of the major drivers of change in the practice of cardiology, in both developed and developing countries, is population change, whose dynamics can be expressed by secular epidemiological and demographic trends, with increasing survival and life expectancy across all age strata. The sole concept of transition, whether epidemiological or demographic, is quite dynamic. From a global health point of view, one element merits attention: developed countries have had longer time to double or triple their population, usually more than one century, whereas the same increases in population size in the developing world occurred just over decades. The epidemiological transition theory, far from being perfect, introduced a booster to the understanding of the changing dynamics of epidemiological profiles and provided a complement to the discourse of the demographic change. In this article, with an special emphasis on the challenges faced by low- and middle-income settings, we describe current debates of the epidemiological transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health systems, prevention and treatment efforts; and physiological traits and human-environment interactions are identified. These challenges provide also an opportunity to redefine the agenda of global health cardiology and global cardiovascular research. This article concludes that a focus on the most populated regions of the world, who bear the highest disease burden related to cardiovascular conditions, will contribute substantially to protect the large gains in global survival and life expectancy accrued over the last decades. It then follows that a renewed workforce in global health cardiology must swiftly adapt to these changing environments. As the world changes, the practice of cardiology, clinical cardiology, global health cardiology and cardiology research will follow suit.

show abstract

Increased Cardiometabolic Risk and Worsening Hypoxemia at High Altitude

Cited by 46 publications

References 49 publications

Cardiometabolic correlates of sleep disordered breathing in Andean highlanders

Cardiometabolic correlates of sleep disordered breathing in Andean highlanders

Obesity as a Conditioning Factor for High-Altitude Diseases

Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors

Contact Info

Product

Resources

About