Relationship between breast arterial calcification and coronary artery disease by invasive coronary angiography in postmenopausal women.

PURPOSE: To evaluate the relationship between the presence of BAC and coronary artery disease (CAD) by invasive coronary angiography (ICA) in postmenopausal women. METHODS: In this cross-sectional study, postmenopausal women (age ≥ 45 years) with history of CAD, who underwent both ICA and digitized mammography, within six months of each other, were enrolled. Women who underwent prior percutaneous coronary intervention, or exhibited grade D breast density (BI-RADS®) or breast cancer upon mammography were excluded. Digital mammograms were identified in the electronic medical record system and reviewed for the presence of BAC, without knowledge of the ICA results by two experienced physicians. The ICA results were obtained from the electronic medical record, and categorized as follows: 1-single-vessel disease; 2-two-vessel disease; and 3-multivessel disease (≥3vessels). For statistical analysis Student t test, Gamma distribution, Chi-square test and logistic regression (odds ratio,OR) were used. RESULTS: Of the 183 postmenopausal women evaluated, 39 (21.3 %) had BAC. Women with BAC were older and had a longer time since menopause when compared to women without BAC (68.2 ± 9.6 × 59.6 ± 10.0 years of age and 19 ± 10.1 × 13.5 ± 8.2 years, respectively) (p < 0.0.0001). Among the clinical and cardiovascular characteristics evaluated, only the incidence of smoking was higher in women with BAC (p = 0.007). There was no difference in the number of affected vessels upon ICA in women with or without BAC (p = 0.683). In multivariate analysis, after adjustment for age, time since menopause and smoking, the presence of BAC was not associated with a significant risk of observing a greater number of affected vessels upon ICA (OR1.07; 95 %CI 0.41-2.76, p = 0.609). CONCLUSIONS: The presence of BAC was not associated with the severity of CAD in postmenopausal women.

Association Between Metabolic Syndrome and Immunohistochemical Profile at Breast Cancer Diagnosis in Postmenopausal Women.

BACKGROUND: The aim of this study was to evaluate the association between metabolic syndrome (MetS) and the immunohistochemical profile of breast cancer (BC) in postmenopausal women. METHODS: This cross-sectional cohort study included 189 women, aged 45 to 75years and amenorrhea >12 months, with newly diagnosed BC and no previous cancer treatment. Clinical, anthropometric and biochemical data were collected, as well as data on BC hormone status (estrogen receptor, ER; progesterone receptor, PR; human epidermal growth factor receptor-2, HER-2), and epithelial proliferative activity (Ki-67). Tumors were divided into 5 subtypes:luminal A, luminal B HER-2 negative, luminal B HER-2 positive, non-luminal HER-2, and triple negative. Women with three or more of the following criteria were diagnosed with MetS: waist circumference ≥88cm; triglycerides ≥150mg/dL; HDL-cholesterol <50mg/dL; blood pressure ≥130/85mmHg; glucose ≥100mg/dL. RESULTS: Sixty-three (33.3%) of the 189 patients had MetS at the time of diagnosis. Women with MetS had a higher frequency of tumors ≤ 2cm than women without MetS (49.2% vs. 31.8%) (P = .038). There were no differences in histological grade, staging, or axillary lymph node metastasis (P > .05). The proportion of PR-positive (P = .006), HER-2-negative (P = .034), and luminal B HER-2-negative (P = .038) tumors was higher among patients with MetS compared to women without MetS (79.4% vs. 61.8%, 89.9% vs. 78.6% and 44.5% vs. 27.8%, respectively). Multivariate analysis adjusted for age, time since menopause and BMI showed a higher risk for luminal B HER-2-negative tumors among women with MetS (OR 2.00, 95% CI 1.03-3.89), obese patients (OR 2.03, 95% CI 1.06-3.90), and women with abdominal obesity (OR 1.96, 95% CI 1.01-4.03). CONCLUSION: In postmenopausal women with newly diagnosed BC, the presence of MetS was associated with smaller tumor size, PR-positive and HER-2-negative status, and the luminal B tumor subtype.

Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women.

INTRODUCTION: Although pelvic floor muscle (PFM) weakness can be associated with pelvic floor dysfunctions, knowledge about the relationship with sexual dysfunction is limited. AIM: The aim of this study was to evaluate the association between PFM strength and sexual function in postmenopausal women. METHODS: An analytical cross-sectional study was conducted on 226 sexually active heterosexual women aged 45-65 years with amenorrhea >12 months and without pelvic floor disorders. The Female Sexual Function Index (FSFI) was used for the evaluation of sexual function (total score ≤26.5 indicating sexual dysfunction). PFM strength was assessed by bidigital vaginal palpation using the modified Oxford scale (score 0-5) and was categorized into nonfunctional (scores 0-1, without contraction) and functional (scores 2-5, with contraction). Three-dimensional transperineal ultrasound was used to evaluate total urogenital hiatus area, transverse and anteroposterior diameters, and levator ani muscle thickness. MAIN OUTCOME MEASURE: The main outcome measure was to determine the relationship between sexual dysfunction and PFM strength. RESULTS: The participants were classified as functional PFM (n = 143) and nonfunctional PFM (n = 83). There were no differences between groups in clinical and anthropometric parameters. A higher percentage of menopausal hormone therapy users was observed in the group with functional PFM (39.2%) compared to the nonfunctional group (24.1%; P = .043). Women classified as functional PFM exhibited greater levator ani muscle thickness than those classified as nonfunctional (P = .049). Women with nonfunctional PFM had poorer sexual function in the desire (P = .005), arousal (P = .001), and orgasm (P = 0.006) domains and in total FSFI score (P = .006) compared to the functional group. There was a weak positive correlation of PFM strength with the desire (r = 0.35; P = .0003), arousal (r = 0.21; P = .013), and orgasm (r = 0.23; P = .033) domains and with total FSFI score (r = 0.28; P = .004). Ultrasonographic levator ani muscle thickness showed a weak positive correlation with PFM strength (r = 0.21; P = .046) and with the arousal domain (r = 0.23; P = .044). Risk analysis adjusted for age, time since menopause, parity, and body mass index showed a lower risk of sexual dysfunction in menopausal hormone therapy users (odds ratio = 0.26; 95% CI 0.11-0.60; P = .002) and in women with greater levator ani muscle thickness (odds ratio = 0.85; 95% CI 0.73-0.98; P = .025). CLINICAL IMPLICATIONS: The maintenance of PFM strength in the climacteric period is an important factor in postmenopausal women's sexual function. STRENGTH & LIMITATIONS: The main strength of the study is that, to our knowledge, this is the first study that evaluated the correlation of PFM strength and 3D transperineal ultrasound with different domains of sexual function in postmenopausal women. The main limitation is the cross-sectional design does not permit to establish a cause-effect relationship. CONCLUSION: Postmenopausal women with PFM dysfunction have poorer sexual function than women with functional PFM. Omodei MS, Marques Gomes Delmanto LR, Carvalho-Pessoa E, et al. Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women. J Sex Med 2019;16:1938-1946.