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Marôco JL, Szymanski LM, Baynard T, Fernhall B. Exercise testing unmasks exaggerated blood pressure independent of fibrinolytic response in Black but not White postmenopausal females. Am J Physiol Heart Circ Physiol 2024; 326:H1053-H1059. [PMID: 38334975 DOI: 10.1152/ajpheart.00023.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/10/2024]
Abstract
Exercise testing unmasks more exaggerated systolic blood pressure responses (SBP) in Black compared with White male adults. Such responses, if translatable to females, may detect racial disparities particularly relevant during menopause. Given the endothelial involvement in BP regulation and as a source of fibrinolytic markers, it follows that fibrinolytic and BP response to exercise could be linked. Thus, we examined BP and fibrinolytic responses to exercise testing in Black and White postmenopausal females. Postmenopausal females (Black = 40; White = 41; 51-70 yr) performed maximal treadmill exercise. BP and blood draws were conducted before and immediately after exercise. Plasma samples, using minimal stasis, were analyzed for tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) activity and antigen, respectively. Resting SBP and fibrinolytic potential were similar between races. Black females exhibited greater increases in SBP during exercise [change (d)=75, 95% CI: 64-86 mmHg, P < 0.001] than White females (d = 60, 95% CI: 48-71 mmHg, P < 0.001). Black compared with White females had smaller changes in tPA (d = 3.27, 95% CI: 2.28-4.27 IU/mL, P < 0.001 vs. d = 5.55, 95% CI: 4.58-6.53, P < 0.001) and PAI-1 (d = -2.89, 95% CI: -4.39 to -1.40 IU/mL, P < 0.001 vs. d = -5.08, 95% CI: -6.59 to -3.61, P < 0.001) activities after exercise. SBP exercise-induced changes were not associated with tPA (r = -0.10, P = 0.42) or PAI-1 (r = 0.13, P = 0.30), without any influence of race (P > 0.05). Our findings show that maximal exercise unmasks risk factors for cardiovascular disease in Black postmenopausal females.NEW & NOTEWORTHY Exaggerated SBP responses to exercise testing are more frequent in Black than in White male adults. Such responses, if translatable to females, may detect early racial disparities arriving during menopause. Because the endothelium regulates BP and fibrinolytic responses, these could be linked during exercise. At peak exercise, Black but not White postmenopausal females had more exaggerated SPB responses regardless of reduced fibrinolytic potential. Maximal exercise unmasked risk factors for cardiovascular disease in Black postmenopausal females.
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Affiliation(s)
- João L Marôco
- Integrative Human Physiology Laboratory, Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, United States
| | - Linda M Szymanski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States
| | - Tracy Baynard
- Integrative Human Physiology Laboratory, Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, United States
| | - Bo Fernhall
- Integrative Human Physiology Laboratory, Manning College of Nursing & Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, United States
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Sánchez-Delgado JC, Jácome-Hortúa AM, Uribe-Sarmiento OM, Philbois SV, Pereira AC, Rodrigues KP, Souza HCD. Combined effect of physical exercise and hormone replacement therapy on cardiovascular and metabolic health in postmenopausal women: A systematic review and meta-analysis. Braz J Med Biol Res 2023; 56:e12241. [PMID: 37194832 DOI: 10.1590/1414-431x2023e12241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/31/2023] [Indexed: 05/18/2023] Open
Abstract
The cardioprotective effect of postmenopausal hormone replacement therapy (HRT) has been demonstrated in several studies. Similarly, physical exercise has yielded positive results. However, the effects of their combination remain inconclusive. This review describes the combined effects of physical exercise and hormone therapy on cardiovascular and metabolic health in postmenopausal women. We searched the Scopus, Web of Science, PubMed, and Embase databases and included randomized controlled trials published up to December 2021 on the combined effects of physical exercise and hormone therapy on cardiovascular and metabolic health in postmenopausal women. We identified 148 articles, of which only seven met the inclusion criteria (386 participants; 91 [23%] HRT + exercise; 104 [27%] HRT; 103 [27%] exercise; 88 [23%] placebo). The combined treatment further decreased systolic blood pressure (SBP) compared to the isolated effect of aerobic training (AT) (mean difference [MD]=-1.69; 95% confidence interval [CI]=-2.65 to -0.72, n=73). Nevertheless, it attenuated the decrease in diastolic blood pressure (DBP) (MD=0.78; 95%CI: 0.22-1.35, n=73), and the increase in peak oxygen consumption (VO2 peak) promoted by exercise (AT + HRT=2.8±1.4 vs AT + placebo=5.8±3.4, P=0.02). The combination of AT and oral HRT improved SBP. However, AT alone seemed to have a better effect on physical fitness and DBP in postmenopausal women.
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Affiliation(s)
- J C Sánchez-Delgado
- Laboratório de Cardiologia, Fisiologia e Fisioterapia, Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Colombia
| | - A M Jácome-Hortúa
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Colombia
| | - O M Uribe-Sarmiento
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Colombia
| | - S V Philbois
- Laboratório de Cardiologia, Fisiologia e Fisioterapia, Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A C Pereira
- Laboratório de Cardiologia, Fisiologia e Fisioterapia, Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - K P Rodrigues
- Laboratório de Cardiologia, Fisiologia e Fisioterapia, Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - H C D Souza
- Laboratório de Cardiologia, Fisiologia e Fisioterapia, Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Hemostatic Responses to Multiple Bouts of Firefighting Activity: Female vs. Male Differences in a High Demand, High Performance Occupation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042124. [PMID: 35206312 PMCID: PMC8872043 DOI: 10.3390/ijerph19042124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022]
Abstract
While the fire service has long been a male-dominated occupation, women's participation in this strenuous, high risk, high performance activity has increased in recent years. Firefighting induces significant cardiovascular strain, including hemostatic disruption; however, the effect of sex on hemostatic responses has not been investigated despite evidence that there are sex-related differences in hemostatic variables at rest and following exercise. Thus, we investigated hemostatic responses in age- and BMI-matched male and female firefighters who performed 3-4 evolutions of firefighting drills over a 3 h period. Venous blood samples were collected before and after the firefighting training drills and hemostatic variables were assessed. Firefighting significantly increased platelet count and factor VIII, tissue plasminogen activator (t-PA) antigen, and t-PA activity, and decreased activated partial thromboplastin time and plasminogen activator inhibitor (PAI-1) activity. Females had lower values for epinephrine-induced platelet closure time, antithrombin III, PAI-1 activity, and PAI-1 antigen. There were no interactions between sex and time for any variables assessed. In conclusion, multiple bouts of firefighting activity resulted in a procoagulatory state. Although there were sex differences for several hemostatic variables, male and female firefighters did not differ in their hemostatic response to multiple bouts of firefighting.
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SMITH DENISEL, HORN GAVINP, PETRUZZELLO STEVENJ, FAHEY GEORGE, WOODS JEFFREY, FERNHALL BO. Clotting and Fibrinolytic Changes after Firefighting Activities. Med Sci Sports Exerc 2014; 46:448-54. [DOI: 10.1249/mss.0b013e3182a76dd2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Effects of body composition and menopause characteristics on maximal oxygen uptake of postmenopausal women. Menopause 2011; 18:1191-7. [DOI: 10.1097/gme.0b013e31821b00b0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jahangard T, Torkaman G, Ghoosheh B, Hedayati M, Dibaj A. The effect of short-term aerobic training on coagulation and fibrinolytic factors in sedentary healthy postmenopausal women. Maturitas 2009; 64:223-7. [DOI: 10.1016/j.maturitas.2009.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 08/29/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
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Endrikat J, Lange E, Kunz M, Schmidt W, Graeser T. A one-year randomized double-blind, multicentre study to evaluate the effects of an oestrogen-reduced, continuous combined hormone replacement therapy preparation containing 1 mg oestradiol valerate and 2 mg dienogest on metabolism in postmenopausal women. EUR J CONTRACEP REPR 2009; 12:229-39. [PMID: 17763261 DOI: 10.1080/13625180701441030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the impact of an oestrogen-reduced, continuous combined hormone replacement therapy preparation containing 1 mg oestradiol valerate (1EV) and 2 mg dienogest (2DNG) on metabolism. METHODS In a randomized double-blind study, 1EV/2DNG was compared with a reference preparation containing 1 mg 17Beta-oestradiol and 0.5 mg norethisterone acetate (E2/NETA). For the primary variable, i.e. the ratio of HDL cholesterol (week 52 to baseline), at least 98 case evaluations were planned. Secondary variables were other lipid parameters, haemostasis factors and carbohydrate metabolism. RESULTS After 1 year of treatment, the mean HDL cholesterol levels had decreased by 4.5 +/- 14.8% in the 1EV/2DNG group and by 6.1 +/- 13.9% in the E2/NETA group (treatment difference NS). The ratio of HDL cholesterol (week 52 to baseline) was 0.944 for 1EV/2DNG and 0.929 for E2/NETA (geometric means). The primary efficacy variable, the ratio of the geometric means of the two treatments (1EV/2DNG/E2/NETA) was 1.016, with a lower one-sided 95% confidence limit of 0.973, which was clearly above the prespecified non-inferiority bound of 0.85 (p-value < 0.001). HDL2 cholesterol increased by 0.3 +/- 34.4% (1EV/2DNG) and decreased by 6.2 +/- 34.3% (E2/NETA; treatment difference NS); HDL3 cholesterol decreased by 4.4 +/- 19.9% (1EV/2DNG) and 8.2 +/- 17.7% (E2/NETA; treatment difference NS). Changes in the haemostasis and carbohydrate variables were very similar in both treatment groups. CONCLUSION This study provides evidence that a new oestrogen-reduced HRT preparation containing 1 mg oestradiol valerate and 2 mg dienogest has no major impact on lipid variables. Minimal changes were seen in haemostatic and carbohydrate variables.
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Physical activity and fibrinogen concentrations in 23,201 men and women in the EPIC-Norfolk population-based study. Atherosclerosis 2008; 198:419-25. [DOI: 10.1016/j.atherosclerosis.2007.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 09/14/2007] [Accepted: 09/18/2007] [Indexed: 11/30/2022]
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Baynard T, Jacobs HM, Kessler CM, Kanaley JA, Fernhall B. Fibrinolytic markers and vasodilatory capacity following acute exercise among men of differing training status. Eur J Appl Physiol 2007; 101:595-602. [PMID: 17676334 DOI: 10.1007/s00421-007-0534-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2007] [Indexed: 10/23/2022]
Abstract
We evaluated the effect of differing physical activity patterns on fibrinolysis and vasodilatory capacity using a cross-sectional design with 16 endurance-trained (ET) (mean+/-SE) (28+/-6 years), 14 resistance-trained (RT) (28+/-7 years), and 10 untrained (UT) (26+/-7 years) men. t-PA and PAI-1 activity and t-PA antigen were measured before and after a maximal treadmill test (VO2peak). Vasodilatory capacity was assessed using strain-gauge plethysmography on the forearm following reactive hyperemia (RH) before and after the treadmill test. The ET group had a smaller body mass index (BMI) (22.8+/-0.5 ET, 26.4+/-0.4 RT, 25.1+/-0.8 UT kg m(-2)) (P<0.05) and a greater VO2peak (57+/-1 ET, 42+/-2 RT, 45+/-2 UT mL min(-1) kg(-1)) (P<0.05). Peak vasodilatory capacity (29.7+/-2 ET, 32.0+/-2 RT, 27.4+/-2 UT mL min(-1) 100 mL of tissue) was similar between groups before and after exercise. Area under the curve for forearm blood flow was greater following acute exercise (212 vs. 122, P<0.05), again with no differences between groups. t-PA activity and antigen increased following maximal exercise in all groups (P<0.0001), with no group differences. PAI-1 activity decreased the least in RT after exercise (70% decrease vs. 86% ET and 82% UT; P<0.05). The change in t-PA activity with exercise was not related to exercise-induced change in overall vasodilatory capacity. These findings demonstrate that in healthy young men different physical activity patterns do not appear to impact the exercise-induced changes in fibrinolysis or vasodilatory capacity.
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Affiliation(s)
- Tracy Baynard
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA.
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