Leigh A. Callahan

Exercise in Sickle Cell Anemia: Effect on Inflammatory and Vasoactive Mediators

The aim of this study was to determine the response of inflammatory and vasoactive mediators to 3 consecutive days of exercise in African-American women with and without sickle cell anemia (SCA). Circulating inflammatory mediators [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNFalpha)] were measured before, and vasoactive mediators [endothelin-1 (ET-1), nitric oxide metabolites (NOx)] before and after each exercise bout in ten subjects with SCA and ten controls. Exercise did not affect ET-1, IL-6 or CRP concentrations (p >.05). TNFalpha was higher in SCA than controls (p < or = .0005) at all times; however, the response pattern was similar for the groups: no change from day 1 to day 2, but a decrease from day 2 to day 3 (p < or = .05). NOx increased significantly after exercise (p < or = .0001) but returned to baseline by 24 h afterward. On the 3rd day, NOx increased after exercise in SCA but not in the controls (p < or = .05). In conclusion, exercise did not cause a harmful inflammatory response in these individuals with SCA. However, NOx increased after exercise on all 3 days in SCA but appeared attenuated after 2 days in controls.

31 – Gender-Specific Considerations in Pulmonary Hypertension

Pulmonary hypertension is an important clinical condition that can progress rapidly, leading to severe disability and death. This chapter reviews the differential diagnosis of pulmonary hypertension, outlining the various conditions that can be associated with this disorder. Many patients with this disorder have secondary pulmonary hypertension, in which the condition is directly linked to disorders that increase pulmonary artery pressures by a well understood pathophysiologic mechanism. However, a substantial number of patients have idiopathic forms of pulmonary hypertension. After initial recognition of the presence of this disorder, the clinician must perform a series of evaluations to differentiate the primary, idiopathic form of this disorder from pulmonary hypertension, which is secondary to disease processes that produce pulmonary hypertension by known pathophysiologic mechanisms. Once adequately categorized, patients must be started on therapeutic regimens that are appropriate for their conditions. Primary pulmonary hypertension demonstrates marked gender predominance, with approximately twice as many woman affected as men. Paradoxically, some data suggest that secondary forms of pulmonary hypertension may affect men more than women. This chapter also describes the symptoms, evaluation, and treatment of patients with the idiopathic pulmonary hypertension syndrome.