Habitation Altitude and Left Ventricular Diastolic Function: A Population‐Based Study

Background Although numerous studies have been published evaluating the positive or negative effects of altitude on cardiovascular disease, many of them are conflicting. Methods and Results Data come from 2 cross-sectional surveys using a similar method in China; and a total of 34 215 residents, aged ≥35 years, were eligible and recruited in the study. Left ventricular diastolic dysfunction (LVDD), according to the 2009 American Society of Echocardiography guidelines, was defined and evaluated. Altitude was divided into low (<1500 m), middle (1500-3500 m), and high (≥3500 m) level groups. Among the 34 215 participants (aged 55.87 years; men, 45.92%; altitude ranging from 3.1 ~ 4507 m), 15 099 (crude prevalence, 44.13%), 517 (crude prevalence, 1.51%), and 272 (crude prevalence, 0.79%) were diagnosed as having grades I, II, and LVDD, respectively. Compared with low-level group, the odds ratios (ORs) (95% CIs) of LVDD for middle- and high-level groups were 1.65 (1.49-1.82) and 1.89 (1.63-2.19), respectively (<i>P</i>_trend<0.001). The ORs (95% CI) were 1.43 (1.31-1.56) and 2.03 (1.67-2.47) per 500-m increment for middle- and high-level groups. There was a nonlinear relationship (upward-sloping "W" shape) between altitude and the risk of LVDD, assessed by the restricted cubic spline. For each LVDD grade, ORs (95% CIs) of grade I LVDD for middle- and high-level groups were 1.75 (1.59-1.92) and 1.95 (1.69-2.25), respectively; for grade II, ORs (95% CIs) for middle- and high-level groups were 6.19 (3.67-10.42) and 5.27 (2.18-12.74), respectively. The stratified analyses indicated that LVDD was much more remarkably influenced by elevated altitude in men (<i>P</i>_interaction=0.0019). Conclusions Higher altitude is associated with increased risk of LVDD among people living over 1500 m, especially for men.