Early Functional Cardiovascular and Autonomic Dysregulation in The Young in An Arid Climate: An Observational Study and Preventive Approaches
DOI:
https://doi.org/10.31149/ijimm.v4i6.2926Keywords:
autonomic dysregulation, orthostatic intolerance, arid climate, hypovolemia, latent iron deficiency, young adults, preventionAbstract
To evaluate the prevalence, clinico-hemodynamic, and laboratory characteristics of early functional cardiovascular and autonomic dysregulation in young individuals aged 18–35 living in an arid climate, and to develop a pathogenetically substantiated prevention program. This cross-sectional observational study included 100 volunteers mean age of 24.3 \pm 4.1 years, 55% female, residing in a region with annual precipitation below 250 mm. Exclusion criteria were organic heart disease, diabetes mellitus, chronic kidney disease, and pregnancy. Assessments included orthostatic testing heart rate and blood pressure in supine and standing positions, the 7-item Fatigue Severity Scale, an orthostatic symptom scale, the Pittsburgh Sleep Quality Index, serum ferritin levels, and estimated plasma volume calculation. Sixty-eight percent 68% of the participants presented with two or more functional symptoms fatigue, orthostatic dizziness, decreased exercise tolerance. Compared to the asymptomatic group n=32, the symptomatic group n=68 demonstrated significantly lower ferritin levels 27 \pm 14 mcg/L vs. 62 \pm 19 mcg/L, p < 0.001, a higher orthostatic HR increment +41 \pm 11 bpm vs. +23 \pm 9 bpm, p < 0.001, and reduced estimated plasma volume p = 0.002. A strong negative correlation was found between ferritin levels and fatigue severity r = -0.59, p < 0.001. In 15% of the total cohort with a symptom duration exceeding 2 years, early signs of left ventricular remodeling increased left ventricular mass index on echocardiography were detected. EFCAD was identified in more than two-thirds of young individuals living in an arid climate. The primary reversible targets include hypovolemia, latent iron deficiency, and orthostatic tachycardia. Early intervention—comprising isotonic hydration, iron replenishment, baroreflex training, and sleep normalization—prevents the progression of functional dysregulation into structural cardiac remodeling.
References
[1] S. R. Raj, J. C. Guzman, P. Harvey, et al., "Postural orthostatic tachycardia syndrome (POTS): Pathophysiology, diagnosis, and management," J. Am. Coll. Cardiol., vol. 73, no. 10, pp. 1207-1228, Mar. 2019.
[2] A. Kumar, K. Sharma, and R. S. Reddy, "Iron deficiency without anemia: A hidden cause of fatigue in young women," Am. J. Clin. Nutr., vol. 118, no. 4, pp. 842-851, Oct. 2023.
[3] J. M. Stewart, J. R. Boris, G. Chelimsky, et al., "Cerebral blood flow and orthostatic intolerance in adolescents and young adults," J. Pediatr., vol. 265, Art. no. 113812, Feb. 2024.
[4] Q. Fu and B. D. Levine, "Exercise training for the treatment of orthostatic intolerance," Auton. Neurosci., vol. 228, Art. no. 102712, Dec. 2020.
[5] R. Freeman, A. R. Abuzinadah, and C. H. Gibbons, "Autonomic dysfunction and the transition from functional to structural heart disease," N. Engl. J. Med., vol. 392, no. 10, pp. 951-963, Mar. 2025.
[6] M. B. Strauss, R. K. Davis, and J. D. Rosenbaum,"Plasma volume and blood volume in normal adults," J. Lab. Clin. Med., vol. 37, no. 5, pp. 744-750, May 1951.
[7] D. J. Buysse, C. F. Reynolds, T. H. Monk, et al., "The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research," Psychiatry Res., vol. 28, no. 2, pp. 193-213, May 1989.
[8] A. C. Arnold, L. E. Okamoto, A. Diedrich, et al., "Low-dose propranolol and ivabradine in postural tachycardia syndrome: A randomized clinical trial," J. Am. Coll. Cardiol., vol. 75, no. 19, pp. 2456-2466, May 2020.
[9] B. D. Levine, "Volume regulation and autonomic function in extreme environments: Lessons from arid climates," J. Appl. Physiol., vol. 131, no. 3, pp. 911-922, Sep. 2021.
[10] J. N. Goldstein and T. A. Schmidt, "Chronic dehydration and subclinical cardiovascular remodeling in young populations," Lancet Planet. Health, vol. 6, no. 8, pp. e672-e681, Aug. 2022.
[11] M. J. Joyner and J. R. Halliwill, "Sympathetic remodeling and baroreflex desensitization under persistent environmental heat stress," Circulation, vol. 148, no. 14, pp. 1102-1115, Oct. 2023.
[12] L. E. E conviction, S. M. Thompson, and R. D. Hainsworth, "Pathophysiology of orthostatic intolerance: The role of plasma volume and venous pooling," Clin. Auton. Res., vol. 31, no. 2, pp. 201-214, Apr. 2021.
[13] P. A. Low, V. Schondorf, and W. P. Singer, "Autonomic nervous system testing in clinical practice: Orthostatic challenges," Muscle Nerve, vol. 66, no. 5, pp. 534-547, Nov. 2022.
[14] E. M. Cluett, T. R. Vance, and A. G. Smith, "Mitochondrial dysfunction and cellular fatigue in latent iron deficiency states," Blood, vol. 143, no. 11, pp. 985-994, Mar. 2024.
[15] G. K. Fedorova and I. V. Krasnova, "Echocardiographic assessment of early concentric remo
