Top Things to Know: Implications for Exercise at Altitude Among Individuals With Cardiovascular Disease

Published: September 09, 2021

  1. Over 100 million individuals travel to mountainous locations each year for work or pleasure, many of whom suffer from cardiovascular disease, hypertension, or heart failure.
  2. Environmental stressors, such as changes in temperature, humidity, pressure, and oxygen availability, uniquely challenge the cardiovascular system and may increase the risk of adverse events.
  3. Patients may experience large increases in blood pressure and pulmonary arterial pressures at high altitude. Ischemia may occur at lower workloads than at sea-level.
  4. Syncope is common, even at moderate altitudes and may occur within 24 hours of ascent.
  5. Sudden cardiac death is the most frequent non-traumatic cause of death at altitude.
  6. Medical resources are scarce and there is limited access to immediate care for individuals suffering from an acute cardiac event.
  7. Risks may be minimized by pre-travel planning through shared decision-making between patients and their clinicians.
  8. Prior to travel, patients and clinicians should review travel plans – including location and duration of travel, activities planned, evacuation options and identification of local medical facilities in the event of a medical emergency.
  9. Pre-travel exercise testing may be considered to assess exercise tolerance at altitude.
  10. A staged ascent and/or period of acclimatization to altitude should be considered, to reduce the risk of cardiovascular events.


Cornwell WK 3rd, Baggish AL, Bhatta YKD, Brosnan MJ, Dehnert C, Guseh JS, Hammer D, Levine BD, Parati G, Wolfel EE; on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology; and Council on Arteriosclerosis, Thrombosis and Vascular Biology. Clinical implications for exercise at altitude among individuals with cardiovascular disease: a scientific statement from the American Heart Association. J Am Heart Assoc. 2021;10:e023225. DOI: 10.1161/JAHA.121.023225