Chest
Original ResearchOccupational And Environmental Lung DiseasesSystemic Vascular Dysfunction in Patients With Chronic Mountain Sickness
Section snippets
Study Subjects and Protocol
Between August 2008 and August 2010, 23 male patients with CMS (mean ± SD age, 52 ± 11 y) and 27 control subjects (49 ± 10 y) without traditional cardiovascular risk factors or a family history of premature cardiovascular events who were born and had been permanently living in La Paz, Bolivia (3,600 m above sea level) were included in the study. Inclusion criteria for patients with CMS were excessive erythrocytosis (hemoglobin concentration > 20 g/dL) in the presence of normal pulmonary
Results
The characteristics of the participants are shown in Table 1. As expected, Sao2 was markedly lower and hemoglobin and hematocrit levels significantly higher in patients with CMS than in control subjects. Arterial BP and lung function, lipid and glucose plasma concentration, WBC count, and hsCRP level were normal and comparable between the two groups.
Discussion
CMS is a major public health problem in mountainous regions of the world, affecting many millions of high-altitude dwellers.1, 2 Although it is well established that this problem is associated with pulmonary vascular dysfunction and right-sided heart failure, there is little information on the systemic circulation. In the present study, we found that patients with CMS without additional cardiovascular risk factors have marked systemic vascular dysfunction as evidenced by impaired FMD, increased
Conclusions
To our knowledge, the present findings provide the first evidence that patients with CMS without additional cardiovascular risk factors have functional and morphological alterations of the systemic circulation. Some of these alterations also were found in hypoxemic high-altitude dwellers who did not experience CMS and were partially reversible during oxygen inhalation, suggesting that chronic hypoxemia may represent one of the underlying mechanisms.
Acknowledgments
Author contributions: Drs Allemann, Scherrer, and Sartorihad full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Rimoldi: contributed to the clinical examinations, study design, data analysis and interpretation, and writing of the first draft of the manuscript.
Dr Rexhaj: contributed to the clinical examinations, data analysis and interpretation, and final writing of the manuscript.
Dr Pratali: contributed to
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2021, PulmonologyCitation Excerpt :Unfortunately, excessive reactive oxygen species concentration can cause vascular endothelial dysfunction, the major underlying factor promoting atherogenesis and CVD.9 Well acclimatized, healthy highlanders have elevated reactive oxygen species concentration without evidence of vascular dysfunction, which is in contrast to observations in highlanders with chronic mountain sickness (CMS).10,11 CMS is characterized by polycythemia, pulmonary hypertension and severe chronic hypoxemia.12
Drs Allemann, Scherrer, and Sartori contributed equally to this work.
Funding/Support: This work was supported by grants from the Swiss National Science Foundation, the Placide Nicod Foundation, and the Leenards Foundation.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).