Altitude-dependent Variation in Lipoprotein Profile as a Predictor of Hypoxic Pulmonary Arterial Hypertension in COPD Patients: An Analysis Across Gradient Altitudes

Abstract

Abstract Background The heterogeneity of the spectrum of lipoproteins plays an important role in pulmonary hypertension, which mainly focuses on arterial types of pulmonary hypertension (PAH), but is little understood for the hypoxic pulmonary hypertension (HPH). Objectives Here, we explore the impact of altitude-induced hypoxia and lipoprotein levels on the occurrence and development of Chronic Obstructive Pulmonary Disease combined with Pulmonary Hypertension (COPD-PH) in high-altitude residents. Methods Clinical data from 245 COPD-PH patients admitted to Qinghai University Affiliated Hospital (2018–2022) were retrospectively analyzed. Patients were divided into middle (1500m-<2500m; 119 cases) and high-altitude (2500m-<4500m; 126 cases) groups, with a control group comprising 100 health-check participants from the same altitudes. Main variables included Pulmonary Arterial Systolic Pressure (PASP), Total Cholesterol (TC), Triglycerides (TG), High-Density Lipoprotein Cholesterol (HDL), and Low-Density Lipoprotein Cholesterol (LDL). Results Differences in Body Mass Index (BMI), PASP, TC, TG, HDL, LDL, and lipoprotein ratios between the control and COPD-PH groups were statistically significant (P < 0.05). Multivariate logistic regression revealed serum TC, HDL ≤ 1.13 mmol/L, and TC/HDL ≥ 3.52 as independent predictors of COPD-PH. In the COPD-PH group, PASP negatively correlated with BMI, TC, and HDL but positively correlated with age, altitude, and TC/HDL. Conclusions Low-oxygen conditions at high altitude are closely related to the severity of pulmonary artery pressure in COPD-PH patients and can influence the occurrence and development of COPD-PH by affecting serum TC and TC/HDL levels. Gender differences in COPD-PH occurrence and prognosis may be linked to TC, HDL, and TC/HDL, suggesting PAH is a gender-bimodal disease primarily affecting females.