Associação das HSP 60 e 70 com fatores de risco cardiovascular em mulheres na pós-menopausa tratadas de câncer de mama.
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2018-04-19
Autores
Buttros, Daniel de Araújo Brito
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Universidade Estadual Paulista (Unesp)
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Objetivo: Avaliar os fatores de risco cardiovascular em mulheres na pós-menopausa tratadas de câncer de mama comparadas a mulheres na pós-menopausa sem câncer de mama e a associação das heat shock proteins (HSP) 60 e 70 com o câncer de mama em mulheres na pós-menopausa. Métodos: Realizou-se estudo clínico de corte transversal com 96 mulheres tratadas de câncer de mama comparadas a 192 mulheres na pós-menopausa (controle), com idades entre 45 e 75 anos. Foram incluídas no grupo principal mulheres com amenorréia > 12 meses e idade ≥ 45 anos, com diagnóstico histológico de câncer de mama, sem doença metastática e sem doença cardiovascular (DCV) estabelecida. O grupo controle foi constituído por mulheres com amenorréia > 12 meses, idade ≥ 45 anos, sem câncer de mama e DCV. Os grupos foram pareados por idade, tempo de menopausa e índice de massa corpórea (IMC) na proporção 1 caso para 2 controles, conforme cálculo amostral, com o mínimo de 92 pacientes tratadas de câncer de mama. Dados clínicos e antropométricos (IMC e circunferência da cintura) foram coletados por meio de entrevista e exame físico. Para análise bioquímica foram solicitados colesterol total, HLD, LDL, triglicerídeos, glicose e insulina. Foram consideradas com síndrome metabólica (SM), as mulheres que apresentaram três ou mais critérios diagnósticos: circunferência da cintura (CC) > 88 cm; TG ³ 150 mg/dL; HDL colesterol < 50 mg/dL; pressão arterial ³ 130/85 mmHg; glicose ³ 100 mg/dL. Para determinação das concentrações plasmáticas de HSP 60 e 70 foram empregados imunoensaios pela técnica de ELISA. A doença aterosclerótica foi determinada pela espessura do complexo médio-intimal (CMI > 1mm) das artérias carótidas e/ou pela presença de placa ateromatosa, avaliadas pela ultrassonografia carotídea (scanner 14 duplex). Para análise estatística foram empregados: Teste t-student, Distribuição Gama (variáveis assimétricas), Teste do Qui-Quadrado e Regressão Logística (odds ratio-OR). Resultados: A média de idade das pacientes tratadas de câncer de mama foi de 59,8 ± 9,0 anos com tempo médio de seguimento de 4,2 ± 2,0 anos. Na comparação entre os grupos, mulheres tratadas de câncer de mama apresentaram valores médios elevados da pressão sistólica e diastólica (p<0.001) e valores médios de triglicerídeos e glicose, acima dos valores desejáveis (p<0.05). As pacientes do grupo principal apresentaram valores mais altos de HSP 60 e mais baixos de HSP 70 quando comparados ao controle (p<0.05). Foi observada maior ocorrência de diabetes, SM e placa ateromatosa entre as mulheres tratadas de câncer mama quando comparadas ao controle (19,8% vs 6,8%; 54,2% vs 30,7%; 19.8% vs 9.4%, respectivamente) (p<0.05). Na análise de risco ajustado para idade, tempo de menopausa e IMC, as mulheres tratadas de câncer de mama apresentaram risco significativamente aumentado para SM (OR=4.21; IC 95% 2.28-7.76), presença de placa ateromatosa (OR=2.61; IC 95% 1.19-5.72), diabetes (OR=4.42; IC 95% 1.86-10.49), hipertrigliceridemia (OR=2.32; IC 95% 1.33-4.0) e circunferência de cintura aumentada (OR=11.22; IC 95% 4.0 – 31.65), quando comparadas as mulheres sem câncer de mama. Conclusão: Mulheres tratadas de câncer de mama apresentaram maior risco para síndrome metabólica, diabetes, doença aterosclerótica, hipertrigliceridemia e obesidade abdominal, importantes fatores de risco para doença cardiovascular, quando comparadas as mulheres na pós-menopausa sem câncer de mama. Assim como, mulheres tratadas de câncer de mama apresentaram valores elevados de HSP 60 e diminuídos de HSP 70 quando comparadas às mulheres sem câncer.
To evaluate cardiovascular risk factors in postmenopausal breast cancer survivors as compared to postmenopausal women without breast cancer and the association of heat shock proteins (HSP) 60 and 70 with breast cancer in postmenopausal women. Methods: In this cross-sectional study, 96 postmenopausal breast cancer survivors were compared with 192 postmenopausal women (controls), aged 45 to 75 years. The principal group included women with amenorrhea > 12 months and age ≥45 years, with histological diagnosis of breast cancer, without metastatic disease and without established cardiovascular disease (CVD). The control group consisted of women with amenorrhea > 12 months, age ≥45 years, without breast cancer and CVD. The groups were matched by age, time since menopause, and body mass index (BMI) in the proportion 1 case for 2 controls, according to the sample calculation, with a minimum of 92 breast cancer survivors. Clinical and anthropometric data (BMI and waist circumference) were collected by interview and physical examination. For biochemical analysis, total cholesterol, HLD, LDL, triglycerides, glucose and insulin levels were measured. Women who presented three or more of the following criteria were diagnosed as having metabolic syndrome (MetS): waist circumference (WC)> 88 cm; TG≥ 150 mg/dL; HDL cholesterol <50 mg/dL; blood pressure ≥ 130/85 mmHg; glucose ≥ 100 mg/dL. For measuring plasma concentrations of HSP 60 and 70, immunoassays by ELISA technique were used. Atherosclerotic disease was determined by the intima-media thickness (IMT> 1mm) of the carotid arteries and / or by the presence of atheromatous plaque, assessed by carotid ultrasound (scanner duplex). For statistical nalysis, Student's t-test, Gamma Distribution (asymmetric variables), Chi-Square Test, and Logistic Regression (odds ratio-OR) were used. Results: The mean (± SD) age of breast cancer survivors was 59.8 ± 9.0 years, with a mean (± SD) follow-up of 4.2 ± 2.0 years. The breast cancer survivors presented high mean values of systolic and distal pressure (p <0.001), and mean values of triglycerides and glucose, above the desirable values (p <0.05). Patients with breast cancer had higher levels of HSP 60 and lower HSP 70 when compared to control (p <0.05). There was a higher occurrence of diabetes, MetS, and atheromatous plaque among the breast cancer survivors when compared to the control group (19.8% vs 6.8%, 54.2% vs. 30.7%, 19.8% vs. 9.4% respectively) (p <0.05). In the risk analysis adjusted for age, time since menopause and BMI, women treated for breast cancer had a significantly increased risk for MetS (OR = 4.21, 95% CI 2.28-7.76), presence of atheromatous plaque (OR = 2.61, CI 95% CI 1.19-5.72), diabetes (OR=4.42; IC 95% 1.86-10.49), hypertriglyceridemia (OR = 2.32, 95% CI 1.33-4.0) and large waist circumference (OR = 11.22, 95% CI 4.0 - 31.65 ) when compared to women without breast cancer. Conclusion: Postmenopausal breast cancer survivors had a higher risk for metabolic syndrome, diabetes, atherosclerotic disease, hypertriglyceridemia and abdominal obesity, important risk factors for cardiovascular disease when compared to postmenopausal women without breast cancer. Similarly, women treated for breast cancer presented high levels of HSP 60 and decreased HSP 70 when compared to women without cancer.
To evaluate cardiovascular risk factors in postmenopausal breast cancer survivors as compared to postmenopausal women without breast cancer and the association of heat shock proteins (HSP) 60 and 70 with breast cancer in postmenopausal women. Methods: In this cross-sectional study, 96 postmenopausal breast cancer survivors were compared with 192 postmenopausal women (controls), aged 45 to 75 years. The principal group included women with amenorrhea > 12 months and age ≥45 years, with histological diagnosis of breast cancer, without metastatic disease and without established cardiovascular disease (CVD). The control group consisted of women with amenorrhea > 12 months, age ≥45 years, without breast cancer and CVD. The groups were matched by age, time since menopause, and body mass index (BMI) in the proportion 1 case for 2 controls, according to the sample calculation, with a minimum of 92 breast cancer survivors. Clinical and anthropometric data (BMI and waist circumference) were collected by interview and physical examination. For biochemical analysis, total cholesterol, HLD, LDL, triglycerides, glucose and insulin levels were measured. Women who presented three or more of the following criteria were diagnosed as having metabolic syndrome (MetS): waist circumference (WC)> 88 cm; TG≥ 150 mg/dL; HDL cholesterol <50 mg/dL; blood pressure ≥ 130/85 mmHg; glucose ≥ 100 mg/dL. For measuring plasma concentrations of HSP 60 and 70, immunoassays by ELISA technique were used. Atherosclerotic disease was determined by the intima-media thickness (IMT> 1mm) of the carotid arteries and / or by the presence of atheromatous plaque, assessed by carotid ultrasound (scanner duplex). For statistical nalysis, Student's t-test, Gamma Distribution (asymmetric variables), Chi-Square Test, and Logistic Regression (odds ratio-OR) were used. Results: The mean (± SD) age of breast cancer survivors was 59.8 ± 9.0 years, with a mean (± SD) follow-up of 4.2 ± 2.0 years. The breast cancer survivors presented high mean values of systolic and distal pressure (p <0.001), and mean values of triglycerides and glucose, above the desirable values (p <0.05). Patients with breast cancer had higher levels of HSP 60 and lower HSP 70 when compared to control (p <0.05). There was a higher occurrence of diabetes, MetS, and atheromatous plaque among the breast cancer survivors when compared to the control group (19.8% vs 6.8%, 54.2% vs. 30.7%, 19.8% vs. 9.4% respectively) (p <0.05). In the risk analysis adjusted for age, time since menopause and BMI, women treated for breast cancer had a significantly increased risk for MetS (OR = 4.21, 95% CI 2.28-7.76), presence of atheromatous plaque (OR = 2.61, CI 95% CI 1.19-5.72), diabetes (OR=4.42; IC 95% 1.86-10.49), hypertriglyceridemia (OR = 2.32, 95% CI 1.33-4.0) and large waist circumference (OR = 11.22, 95% CI 4.0 - 31.65 ) when compared to women without breast cancer. Conclusion: Postmenopausal breast cancer survivors had a higher risk for metabolic syndrome, diabetes, atherosclerotic disease, hypertriglyceridemia and abdominal obesity, important risk factors for cardiovascular disease when compared to postmenopausal women without breast cancer. Similarly, women treated for breast cancer presented high levels of HSP 60 and decreased HSP 70 when compared to women without cancer.
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Palavras-chave
câncer de mama, risco cardiovascular, menopausa, heat shock protein