Faeh David, Gutzwiller Felix, Bopp Matthias
University of Zurich, Institute of Social and Preventive Medicine, Hirschengraben 84, 8001 Zürich, Switzerland.
Circulation. 2009 Aug 11;120(6):495-501. doi: 10.1161/CIRCULATIONAHA.108.819250. Epub 2009 Jul 27.
Studies assessing the effect of altitude on cardiovascular disease have provided conflicting results. Most studies were limited because of the heterogeneity of the population, their ecological design, or both. In addition, effects of place of birth were rarely considered. Here, we examine mortality from coronary heart disease and stroke in relation to the altitude of the place of residence in 1990 and at birth.
Mortality data from 1990 to 2000, sociodemographic information, and places of birth and residence in 1990 (men and women between 40 and 84 years of age living at altitudes of 259 to 1960 m) were obtained from the Swiss National Cohort, a longitudinal, census-based record linkage study. The 1.64 million German Swiss residents born in Switzerland provided 14.5 million person-years. Relative risks were calculated with multivariable Poisson regression. Mortality from coronary heart disease (-22% per 1000 m) and stroke (-12% per 1000 m) significantly decreased with increasing altitude. Being born at altitudes higher or lower than the place of residence was associated with lower or higher risk.
The protective effect of living at higher altitude on coronary heart disease and stroke mortality was consistent and became stronger after adjustment for potential confounders. Being born at high altitude had an additional and independent beneficial effect on coronary heart disease mortality. The effect is unlikely to be due to classic cardiovascular disease risk factors and rather could be explained by factors related to climate.
评估海拔高度对心血管疾病影响的研究得出了相互矛盾的结果。大多数研究存在局限性，原因在于人群的异质性、其生态学设计，或两者皆有。此外，出生地的影响很少被考虑。在此，我们研究1990年居住地海拔高度以及出生时海拔高度与冠心病和中风死亡率之间的关系。
从瑞士国民队列研究中获取了1990年至2000年的死亡率数据、社会人口统计学信息以及1990年的出生地和居住地信息（年龄在40至84岁之间、居住在海拔259至1960米的男性和女性），该研究是一项基于人口普查的纵向记录链接研究。出生在瑞士的164万德裔瑞士居民提供了1450万人年的数据。采用多变量泊松回归计算相对风险。冠心病死亡率（每1000米降低22%）和中风死亡率（每1000米降低12%）随海拔升高而显著降低。出生时的海拔高于或低于居住地与较低或较高的风险相关。
居住在较高海拔对冠心病和中风死亡率的保护作用是一致的，在对潜在混杂因素进行调整后变得更强。出生在高海拔地区对冠心病死亡率有额外的独立有益影响。这种影响不太可能归因于经典的心血管疾病危险因素，而更可能由与气候相关的因素来解释。
