Abstract
The detailed characteristics of strokes at high altitudes in diverse nations have not been extensively studied. We retrospectively enrolled 892 cases of first-ever acute ischemic strokes at altitudes of 20, 2550, and 4200 m in China (697 cases from Penglai, 122 cases from Huzhu, and 73 cases from Yushu). Clinical data and brain images were analyzed. Ischemic strokes at high altitudes were characterized by younger ages (69.14 ± 11.10 vs. 64.44 ± 11.50 vs. 64.45 ± 14.03, p < 0.001) and larger infract volumes (8436.37 ± 29,615.07 mm3 vs. 17,213.16 ± 47,044.74 mm3 vs. 42,459 ± 84,529.83 mm3, p < 0.001). The atherosclerotic factors at high altitude, including diabetes mellitus (28.8% vs. 17.2% vs. 9.6%, p < 0.001), coronary heart disease (14.3% vs. 1.6% vs. 4.1%, p < 0.001), and hyperlipidemia (20.2% vs. 17.2% vs. 8.2%, p = 0.031), were significantly fewer than those in plain areas. Polycythemia and hemoglobin levels (138.22 ± 18.04 g/L vs. 172.87 ± 31.57 g/L vs. 171.81 ± 29.55 g/L, p < 0.001), diastolic pressure (89.98 ± 12.99 mmHg vs. 93.07 ± 17.79 mmHg vs. 95.44 ± 17.86 mmHg, p = 0.016), the percentage of hyperhomocysteinemia (13.6% in Penglai vs. 41.8% in Huzhu, p < 0.001), and the percentage of smoking (33.1% in Penglai vs. 50.0% in Huzhu, p = 0.023) were significantly elevated at high altitudes. We concluded that ischemic stroke occurred earlier and more severely in the Chinese plateau. While the atherosclerotic factors were not prominent, the primary prevention of strokes at high altitudes should emphasize anticoagulation, reducing diastolic pressure, adopting a healthy diet, and smoking cessation.
Highlights
Cerebrovascular disease is one of major causes of death and disability around the world
A large Swiss national cohort study conducted by Faeh and colleagues [6] and a study of U.S hemodialysis patients at different altitudes conducted by Winkelmayer and colleagues [7] both suggested protective effects of living at high altitudes on stroke mortality and stroke prevalence
A possible mechanism for this may be related to hypoxia-inducible factor (HIF), which has conferred resistance against ischemia and improved function after myocardial infarction [8,9], as well as acting as a neuroprotective agent and a novel target for stroke therapy [10]
Summary
Cerebrovascular disease is one of major causes of death and disability around the world. Since China has a vast territory and diverse geographical environment, cerebrovascular diseases in different regions possess diverse characteristics. China has a large plateau area, cerebrovascular disease at high altitudes has not been extensively studied. Strokes in each high-altitude area have their own characteristics due to differences in reginal climates, socioeconomics, and local traditional lifestyles. A large Swiss national cohort study conducted by Faeh and colleagues [6] and a study of U.S hemodialysis patients at different altitudes conducted by Winkelmayer and colleagues [7] both suggested protective effects of living at high altitudes on stroke mortality and stroke prevalence. Jha and colleagues in Chadimandir, India [11], revealed that long-term residence at high altitudes was associated with a higher risk of stroke and large infarcts
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
