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Early menopause (prior to age 46 years) due to bilateral oophorectomy results in an abrupt loss of estrogen and other ovarian hormones and an increased risk of cardiovascular disease (CVD). Administration of estrogen partially mitigates this increased CVD risk; however, optimal dosing strategies for lowering CVD risk have not been studied. Current standard care is to use a dose of estrogen higher than that used for vasomotor symptom treatment in women after natural menopause in order to approximate the physiologic estradiol levels in premenopausal women (standard care); however, estradiol levels are not generally measured. An individualized approach that titrates estradiol levels to premenopausal hormone levels (individualized dosing) may be better for CVD risk mitigation in this younger population. The goal of this study was to compare the effect of estradiol dosing strategies (standard care vs. individualized dosing) on subclinical predictors of CVD in women with early menopause due to bilateral oophorectomy. We studied a total of 18 women at baseline and 6 months following surgical and medical intervention: 6 women underwent bilateral oophorectomy and were treated with standard care (age 41±2 years), 7 women underwent bilateral oophorectomy followed by estrogen therapy dosage based on individualized dosing (39±2 years), and 5 women served as time controls (did not undergo bilateral oophorectomy and were studied during the early‐follicular phase of the menstrual cycle at both visits; 34±3 years). At each time point, we assessed parameters of subclinical CVD including resting aortic blood pressure, carotid‐femoral pulse wave velocity, and blood pressure changes during a handgrip test and a cold pressor test. At baseline, serum estradiol levels were similar amongst groups (p>0.05). After 6 months, women who received individualized dosing of estrogen therapy had higher serum estradiol levels (179±23 pg/ml) than women who received standard care (53±25 pg/ml, p=0.01) and women in the control group (78±27 pg/ml, p=0.03). Systolic and diastolic aortic blood pressures did not change between baseline and 6 months, nor did they differ amongst groups at any time point (p>0.05 for all). There were no group or time differences in the change in mean blood pressure during the handgrip exercise or cold pressor test across 6 months (p>0.05 for all). Over a 6‐month follow‐up, despite differences in serum estradiol levels following two different estradiol dosing strategies after bilateral oophorectomy, there were no group differences or detrimental changes in subclinical CVD parameters across time. It is yet to be seen if differences in these parameters will be apparent following a longer duration after bilateral oophorectomy.

Humans with high affinity hemoglobin (HAH) develop compensatory polycythemia, an elevated hematocrit, which increases blood viscosity and may compromise cardiac output during exercise. In addition, humans with HAH have shown alterations in muscle blood flow during exercise in normoxia and hypoxia. As such, we aimed to investigate the influence of HAH and compensatory polycythemia on the central hemodynamic response during both normoxic and hypoxic exercise. METHODS Seven humans with HAH (4 females, 36 ± 13 years) and 11 healthy controls with normal oxygen binding affinity (4 females, 39 ± 10 years) performed cycling exercise at two intensities, 1) at a power output corresponding to 15% below normoxic gas exchange threshold (GET) for four minutes and 2) at a power output requiring 85% of normoxic maximal aerobic capacity until exhaustion. This protocol was performed during both normoxia and hypoxia (21% O 2 and 15% O 2 , respectively). Hemodynamic measurements were taken after three minutes of cycling at 15% below normoxic GET, three minutes at 85% V̇O 2max , and at exhaustion. Cardiac output (Q̇) was estimated using an open‐circuit acetylene wash‐in technique. Stroke volume (SV) was calculated by dividing Q̇ by heart rate (HR). Baseline characteristics were compared between groups with student’s two‐tailed unpaired t‐tests. Hemodynamics were analyzed using a two‐way repeated measures analysis of variance to examine the effects of group and exercise intensity. RESULTS As expected, hematocrit was ~15% greater in the HAH group than the control group (HAH: 58 ± 7 % vs CTL: 43 ± 3 %, P<0.001). Both groups elicited an increase in Q̇ and HR as exercise intensity increased during both normoxia (P<0.001 for both) and hypoxia (P<0.001 and P=0.002, respectively). There was no significant difference in Q̇ between groups during normoxia (P=0.85) or hypoxia (P=0.69). In addition, neither HR nor SV were different between groups during exercise in normoxia (P=0.13 and P=0.39, respectively) or hypoxia (P=0.89 and P=0.73, respectively). There was no group by intensity interaction for Q̇, HR, or SV during normoxia (all, P>0.42) or hypoxia (all, P>0.63). CONCLUSION Our data suggest that cardiac output is not compromised during normoxic or hypoxic exercise in humans with HAH and compensatory polycythemia. Therefore, compensatory polycythemia may improve exercise capacity in humans with HAH by raising oxygen carrying capacity without limiting cardiac output.

Background During the menopause transition, women are at an increased risk of developing hypertension, which is a key marker of cardiovascular disease (CVD). Although historically hot flashes have been considered a quality‐of‐life issue, emerging data provides a link between hot flashes and risk of CVD. Poor renal function is suggested to be one of the key physiological contributors to increased risk of hypertension and CVD among women with hot flashes. Thus, the aim of this study was to characterize the relationship between hot flashes and renal function in peri‐ and post‐menopausal women using a retrospective chart review. We hypothesized that women with hot flashes would demonstrate reduced renal function compared to women without hot flashes. Methods We performed a chart review using serum creatinine and estimated glomerular filtration rate (eGFR) as proxies to assess renal function. Electronic health records for Mayo Clinic patients across multiple sites were abstracted for female patients who were diagnosed with peri‐ or post‐menopause between 2016 and 2020, between 45 and 55 years of age, and had available creatinine laboratory test results. Data regarding demographics, anthropometrics, systemic blood pressure, menopausal stage, occurrence of hot flashes, and comorbidities were extracted from electronic health records. Differences between women with and without hot flashes were evaluated using two‐tailed, independent samples t‐tests. We completed a univariate analysis of variance testing the main effects of menopausal status (peri‐ or post‐menopausal) and presence of hot flashes (yes or no). Given the potential modifying effects of menopause, analytical models were performed in duplicate with and without models separated by menopausal status (peri‐and post‐menopause). Results Data from 83 medical charts were assessed, including 57 women with hot flashes and 26 women without hot flashes. Without separating by menopausal status, there were no hot flash‐related differences in age (51 ± 3 vs. 51 ± 3 years, P = 0.64) or body mass index (30 ± 7 vs. 33 ± 11, P = 0.19) between women with and without hot flashes. Additionally, there were no hot flash‐related differences in metrics of blood pressure, including systolic (120 ± 13 vs. 125 ± 20, P = 0.19), diastolic (75 ± 11 vs. 77 ± 13, P = 0.54), and mean arterial pressure (90 ± 11 vs. 92 ± 14, P = 0.62). There were also no hot flash‐related differences in indicators of renal function, including creatinine (0.8 ± 0.1 vs. 0.8 ± 0.2, P = 0.65) and eGFR (88 ± 11 vs. 85 ± 16, P = 0.36). The clinical characteristics of the perimenopausal versus postmenopausal women are summarized in Table 1 by hot flash status . There were no main effects of hot flash or menopausal status on creatinine (menopausal stage: p=0.810, hot flash status: p=0.659, interaction effect: p=0.983) or eGFR (menopausal stage: p=0.508, hot flash status: p=0.405, interaction effect: p=0.834). Conclusions In this retrospective chart review of peri‐ and post‐menopausal women, there were no differences in systemic blood pressure or renal function between groups. Future investigations may include longitudinal markers of renal function and metrics describing frequency and severity of hot flashes.

Sex-related differences in respiratory modulation of sympathetic activity have been observed in rodent models of sleep apnea [intermittent hypoxia (IH)]. In light of sex disparities in the respiratory response to acute IH in humans as well as changes in respiratory modulation of muscle sympathetic nerve activity (MSNA) in clinical sleep apnea, we examined sex-related differences in respiratory modulation of MSNA following acute IH. We hypothesized that respiratory modulation of MSNA would be altered in both male and female participants after IH; however, the respiratory patterning of MSNA following IH would be sex specific. Heart rate, MSNA, and respiration were evaluated in healthy male ( n = 21, 30 ± 5 yr) and female ( n = 10, 28 ± 5 yr) participants during normoxic rest before and after 30 min of IH. Respiratory modulation of MSNA was assessed by fitting polynomials to cross-correlation histograms constructed between sympathetic spikes and respiration. MSNA was elevated after IH in male (20 ± 6 to 24 ± 8 bursts/min) and female (19 ± 8 to 22 ± 10 bursts/min) participants ( P < 0.01). Both male and female participants exhibited respiratory modulation of MSNA ( P < 0.01); however, the pattern differed by sex. After IH, modulation of MSNA within the breath was reduced in male participants ( P = 0.03) but increased in female participants ( P = 0.02). Both male and female adults exhibit changes in respiratory patterning of MSNA after acute IH; however, this pattern differs by sex. These data support sex disparities in respiratory modulation of MSNA and may have implications for conditions such as sleep apnea.

Background Muscle sympathetic nerve activity (MSNA) is augmented in patients with sleep apnea. This increase in activity is due to increases in firing probability and mean firing rates of individual vasoconstrictor neurons, in addition to multiple within‐burst firing; however, contributing mechanisms and the impact of such firing patterns on peripheral vascular tone are less clear. We examined the effect of acute intermittent hypoxia (IH) on sympathetic neural firing and recruitment strategies and the relationship between changes in MSNA and neurovascular transduction following acute IH. We hypothesized exposure to acute IH would increase MSNA via an increase in action potential (AP) discharge rates and within‐burst firing. We further hypothesized any change in discharge patterns following acute IH would be positively related to a change in neurovascular transduction. Methods Blood pressure (brachial arterial catheter) and MSNA (microneurography of the peroneal nerve) were assessed in 17 healthy adults (11M/6F; 31 ± 1 yrs) during quiet normoxic rest prior to and following 30‐min of experimental IH [30‐s hypoxic (0.05 F i O 2 ) exposures alternating with 90‐s room air breathing]. AP patterns were studied from the filtered raw MSNA signal using wavelet‐based methodology. The slope of the relationship between diastolic blood pressure (DBP) and the preceding MSNA burst area at a fixed cardiac cycle lag was used to quantify neurovascular transduction. Results IH resulted in 15 events where oxygen saturation was reduced (S p O 2 : 99 ± 1% vs 92 ± 1%, P <0.01). Compared to baseline, multi‐unit MSNA burst incidence (33 ± 4 to 43 ± 5 bursts/100 heart beats), AP incidence (272 ± 50 to 501 ± 112 AP/100 heart beats) and AP content per integrated burst (7 ± 1 to 10 ± 1 AP/burst; 4 ± 1 to 5 ± 1 clusters/burst) were increased following IH (all P< 0.05). Neurovascular transduction was not altered following IH ( P =0.34); however, there was a positive relationship between the change (Δ) in neurovascular transduction (mmHg/%/s) and changes in AP discharge rate (AP/100 heart beats; R=0.52, P= 0.03) and within‐burst firing (AP/burst; R=0.38, P= 0.14) following IH. Conclusions Acute IH increases sympathetic neuronal discharge by increasing within‐burst firing of low‐threshold axons. A positive relationship exists between increases in the neural discharge rates and neurovascular transduction following acute IH, such that those individuals with the greatest increase in AP firing exhibited the greatest increase in transduction of sympathetic activity into blood pressure. These data may have important implications for mechanistic understanding of sympathetic activation in sleep apnea and its down‐stream effects, including the development of hypertension and cardiovascular disease. Support or Funding Information Funding: NIH HL130339, Mayo Clinic Center for Biomedical Discovery, Mizzou HES PURE, APS UGSRF. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Objective The slope ratio (SR) is a metric that uses maximal expiratory flow‐volume (MEFV) curves to quantify lung‐emptying dynamics. SR values between 0.5–2.5 indicate homogeneous lung‐emptying, while values >2.5 are suggestive of heterogeneous lung‐emptying. Albuterol and exercise are commonly used to improve airflow in patients with cystic fibrosis (CF); however, the effects of these treatments on lung‐emptying dynamics are unknown. We hypothesized that SR values would decrease following albuterol and/or exercise, and that these decreases would be more pronounced following albuterol‐with‐exercise. Methods Nine patients (25±2 yrs, n=4 male, 5 female) diagnosed (genotype or sweat chloride) with CF underwent three interventions: i) albuterol (2.5 mg in 3 mL saline), ii) 30 mins of exercise (50% peak wattage), and iii) albuterol and exercise together. MEFV curves (spirometry) were obtained at 10 time points: immediately before (Pre) and 15 minutes after (T15) interventions. Forced expiratory volume in 1 second (FEV 1 ) and forced expiratory flow for 25–75% (FEF 25–75 ) of the forced vital capacity (FVC) were calculated for each curve. SR was calculated along the MEFV curve as the ratio between the tangent and chord slopes at serial volumes (200 mL increments), and SR values from 80%‐20% FVC were averaged to produce a single SR for each MEFV curve. Results Compared to exercise, albuterol and albuterol‐with‐exercise elicited greater increases in FEV 1 (Pre: 3.00±0.26 vs 2.99±0.25 vs 3.06±0.23 L, p>0.05; T15: 3.00±0.27 vs 3.27±0.30 vs 3.34±0.28 L, p=0.03; exercise vs albuterol vs exercise‐with‐albuterol, for each comparison respectively), FEF 25–75 (Pre: 2.52±0.40 vs 2.53±0.40 vs 2.57±0.36 L/s, p>0.05; T15: 2.48±0.39 vs 3.04±0.54 vs 3.10±0.43 L/s, p=0.04), and FVC (Pre: 4.19±0.38 vs 4.17±0.38 vs 4.22±0.37 L, p>0.05; T15: 4.16±0.39 vs 4.35±0.38 vs 4.40±0.41 L, p=0.02), as well as greater decreases in SR (Pre: 1.51±0.15 vs 1.56±0.12 vs 1.58±0.12, p>0.05; T15: 1.54±0.15 vs 1.46±0.17 vs 1.43±0.17, p=0.02). Changes in FEV 1 , FEF 25–75 , FVC, and SR were not different between albuterol and albuterol‐with‐exercise conditions (p>0.05). Reductions in SR were related to increases in FEV 1 following interventions (r=−0.55, p<0.01). Conclusions In contrast to exercise, albuterol caused CF patients to exhibit greater increases in FEV 1 , FEF 25–75 , and FVC, along with greater decreases in SR. There was no additive effect of exercise on albuterol. Changes in FEV 1 and SR were inversely correlated. These data suggest that albuterol promotes bronchodilation and homogeneous lung‐emptying in CF patients, and that the SR metric is effective for assessing patterns of bronchodilation following administration of different bronchodilators. Support or Funding Information Supported by HL131151 (SEB) and Mayo Clinic Internal Funding This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

PURPOSE Sympathetic nervous system responses to voluntary apnea are increased by hypoxia and attenuated by hyperoxia. However, whether neural firing and recruitment strategies in response to apnea can be modified by hypoxia and/or hyperoxia were previously unknown. We examined the influence of chemoreceptor stimuli on sympathetic neural firing and recruitment strategies during voluntary end‐expiratory apnea. We hypothesized increases in the firing frequency and probability of low‐threshold axons during apnea would be exaggerated during hypoxia and attenuated during hyperoxia. METHODS Multi‐unit muscle sympathetic nerve activity (MSNA, microneurography) was measured in 10 young, healthy men (31±2 yrs, 25±1 kg/m 2 ). Data were collected at baseline and during maximal voluntary end‐expiratory apnea under normoxic (S p O 2 : 98±1%), hypoxic (F i O 2 : 0.17±0.01; S p O 2 : 82±1%), and hyperoxic (F i O 2 : 0.92±0.03; S p O 2 : 100±0%) conditions. Condition order was randomized and trials were separated by a minimum of 15‐min quiet normoxic rest. Action potential (AP) patterns were studied from the filtered raw signal using wavelet‐based methodology. Data are reported from the last 2‐min of baseline and during the second half of apnea, reflecting the time of highest MSNA. RESULTS There was an increase in multi‐unit MSNA (24±3 to 35±3 bursts/min, p=0.04) during normoxic apnea, which was due to an increase in the frequency and incidence of AP spikes (243±75 to 519±134 AP/min, p=0.048; 412±133 to 773±185 AP/100 heart beats, p=0.04). An increase in the probability of AP firing more than once per burst was also observed (p=0.01). There was an increase in multi‐unit MSNA (20±4 to 46±7 bursts/min, p<0.01) during hypoxic apnea that was due to an increase in the frequency and incidence of AP spikes (192±59 to 952±266 AP/min, p<0.01; 326±89 to 1212±327 AP/100 heart beats, p<0.01). Hypoxic apnea also resulted in an increase in the probability of AP firing more than once per burst (p<0.01). Hyperoxia attenuated any increase in MSNA with apnea, such that no changes in multi‐unit MSNA (24±4 to 28±5 bursts/min, p=0.14) nor frequency or incidence of AP spikes (155±35 to 253±71 AP/min, p=0.12; 249±61 to 502±188 AP/100 heart beats, p=0.28) were observed. Hyperoxia also attenuated any increase in the probability of AP firing more than once per burst (p=0.47). CONCLUSION These data are the first to show neural firing and recruitment strategies in response to voluntary end‐expiratory apnea are modified by hypoxia and hyperoxia. Our results demonstrate that hypoxic apnea increases the frequency and incidence of action potential spikes, as well as the probability of multiple within‐burst firing; whereas this response was suppressed when individuals were hyperoxic. These data may have important implications for neural control of the circulation in recreational activities (i.e. diving) and/or clinical conditions prone to apnea (i.e. sleep apnea). Support or Funding Information FUNDING: AHA #15SDG25080095, NIH HL130339, Natural Sciences and Engineering Research Council of Canada Discovery Grant program. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Pulmonary artery capacitance (Pa CAP ) is the ability of the pulmonary artery to accept a volume of blood at a given pressure. Measured invasively with heart catheterization; Pa CAP can be estimated non‐invasively through the measurement of end‐tidal CO 2 (P ETCO2 ) and stroke volume (SV), known as gas‐exchange capacitance (GX CAP ). We have shown that GX CAP is decreased at rest as well as during peak exercise in patients with cystic fibrosis (CF), when compared to healthy subjects. To determine whether GX CAP is different in CF and controls at a workload that matches for SV. 9 CF patients (age=22±3yrs, BMI=23±1kg/m 2 , VO 2 =19±1mL/kg/min, FEV 1 =81±8%pred.) and 13 healthy subjects (age=28±3yrs, BMI=25±1kg/m 2 , VO 2 =23±2L/min, FEV 1 =93±3%pred.) were studied. Exercise testing was performed on a cycle ergometer. P ETCO2 was assessed using a metabolic cart, SV was calculated from heart rate and cardiac output (Q) using the acetylene rebreathe technique and GX CAP was calculated as the product of P ETCO2 and SV. When matched for workload which sought to match SV, there was a significant difference in CF and healthy subjects in workload (Watts=72±6 vs. 90±4W), but no difference in percent of max watts (%MaxW=63±4 vs. 66±5W), Q (11±1 vs. 13±1L/min), or SV (89±4 vs. 90±4ml/beat). When matched, the previous difference in GX CAP in healthy and CF was abolished (GX CAP =32±2 vs. 32±2mL/BEAT • min). P ETCO2 was similar between CF and healthy subjects (P ETCO2 36±1 and 35±1mmHg). When matched for SV, GX CAP was statistically similar in CF. In relatively healthy CF there is no evidence of pulmonary vasculature dysfunction. NIH RO1 HL108962‐02

Background Although lower vs. healthy individuals, diffusion capacity of lungs for carbon monoxide (DL CO ) and nitric oxide (DL NO ) (may influence oxygen uptake, VO 2 ) are higher during exercise vs. rest in cystic fibrosis patients (CF). Thus, because the Fick equation suggests cardiac output (Q) increases linearly with VO 2 , we sought to study relationships between VO 2 with cardiac function from rest to peak exercise as increases in Q, DL CO and DL NO occur during exercise in CF. Methods 50 individuals participated (ages 22 ± 2 vs. 27 ± 2, BSA = 1.7 ± 0.1 vs. 1.8 ± 0.0 m 2 , VO 2peak = 24 ± 2 vs. 35 ± 2 ml/kg/min, CF (n = 19) vs. controls (CTL, n = 31), mean ± SEM, p<0.05 for all). Acetylene rebreathe was used to assess Q and calculate stroke volume (SV), and standard gas‐exchange was used to assess VO 2 (mL/kg/min). Cardiac power (CP, Q i × MAP) and stroke work (SW, SV i × MAP) were calculated. Q and SV were indexed to BSA (Q i and SV i ). Results Linear regression (R 2 ) between VO 2 with SV i , Q i , CP, and SW at rest were similarly negligible for CF vs. CTL (p=ns). At 50 % VO 2peak , R 2 between VO 2 with SV i (0.25 and 0.43, p<0.05), Q i (0.37 and 0.41, p<0.05), CP (0.18, p=ns and 0.25, p<0.05), and SW (0.12 and 0.30, p=ns) improved for CF and CTL, respectively. At VO 2peak , stronger R 2 between VO 2 with SV i (0.41, p<0.05), Q i (0.47, p<0.05), CP (0.24, p<0.05), and SW (0.19, p=ns) occurred in CF; but, R 2 weakened in CTL (0.28, p<0.05; 0.33, p<0.05; 0.07, p=ns; 0.02, p=ns, respectively). Conclusions From rest to VO 2peak the relationship between VO 2 with cardiac function improves in CF patients. Participation in exercise may benefit relationships between gas‐transfer with cardiac hemodynamics in CF patients.