HARVARD GAZETTE ARCHIVES

Researchers found that though the mountain dwellers on average had higher blood pressure, cholesterol levels, and blood fats, they died from heart disease at less than half the rate of the lowlanders. (Photo montage Georgia Bellas/Harvard News Office)

Residents of a village at an altitude of 3,100 feet suffered fewer heart attacks and lived longer than people in two nearby lowland areas, researchers from Harvard and the University of Athens found. Their study followed 1,198 men and women for l5 years.

Although the mountain dwellers on average had higher blood pressure, cholesterol levels, and blood fats, they died from heart disease at less than half the rate of the lowlanders. Death rates were 61 percent lower for the men, 54 percent lower for the women.

Greater physical activity and adaptation to reduced oxygen levels at moderate and high altitudes are responsible for their longer lives, the scientists conclude.

"The benefits of daily physical activity are well-known," notes Dimitrios Trichopoulos of the Harvard School of Public Health, who led the research. "The physical strain and energy cost of walking are greater on uphill slopes than on level ground. In addition, acclimation to lower levels of oxygen, which improves endurance in athletes, probably conveys greater benefit than physical activity at sea level."

'The physical strain and energy cost of walking are greater on uphill slopes than on level ground,' says Dimitrios Trichopoulos of the Harvard School of Public Health. 'In addition, acclimation to lower levels of oxygen, which improves endurance in athletes, probably conveys greater benefit than physical activity at sea level.' (Photo Stephanie Mitchell/Harvard News Office)

Such activity for both highland and lowland men consists mainly of farming and animal breeding. That would explain the difference between men and women in the amount of benefit, Trichopoulos and his colleagues speculate. "Engagement of women in household activities may imply less physical activity compared with men," they report in the April issue of The Journal of Epidemiology and Community Health.

Could these findings be applied to people in other countries, including the United States? "Yes, I would expect so," Trichopoulos answers. Daily exercise has proved to be a good way to keep a heart healthy and to extend life no matter where people live. "It's possible that daily exercise at moderately high altitudes might add a couple of years to life span," he says.

A big occasion

This study began in 1981 when Eftihios Voridis of the University of Athens, in collaboration with Trichopoulos, coordinated an extensive health survey in three villages about 125 miles from Athens. The mountain village is located in the Sterea Hellas region at an altitude of about 3,100 feet. The plains villages, Zevgolatio and Aidonia, stand in the Peloponnesus region.

"Our visit was a big occasion in these rural areas," recalls Trichopoulos, now Vincent L. Gregory Professor of Cancer Prevention at Harvard. "The people were very eager to participate and we selected 1,198 volunteers. They were enthusiastic about the opportunity to be examined by us at a time when health services in rural Greece were rudimentary."

In those days, no "informed consent" forms had to be filled out. Also, the importance of high-density (good) cholesterol, body fat distribution, and the Mediterranean diet were not yet widely known. "However, I do not think that taking these effects into account would have alerted our results," Trichopoulos says.

By 1996, 308 of the study participants had died. The researchers retrieved and reviewed their death certificates and statistically adjusted the results for age, education, weight, smoking, alcohol consumption, blood pressure, total cholesterol, blood sugar, blood fats, and uric acid. With all that taken into account, death rates from all causes were 43 percent lower among men, and 31 percent lower among women, in the mountains than in the lowlands.

One surprise involved the finding that those with the highest levels of education, especially women, died at increased rates. The researchers explain the unexpected findings by assuming that people with less education, particularly women, "may be physically more active and adhere more closely to a traditional, and presumably more healthy, diet."