Endothelial function in patients with COPD: an updated systematic review of studies using flow-mediated dilatation

ABSTRACT

Introduction

Cardiovascular disease is a significant cause of morbidity and mortality in COPD. Endothelial dysfunction is suggested to be involved in cardiovascular disease pathogenesis, and multiple studies report endothelial dysfunction in COPD. This article summarized the current knowledge on endothelial function in COPD patients.

Areas covered

Databases were screened until November 2022 for studies using ultrasound-based flow-mediated dilation in patients with stable COPD. Pooled effect sizes were calculated using random effects model. Meta-regression analyses assessed the effects of demographic and clinical variables.

Expert opinion

34 studies were identified (1365 COPD patients; 617 controls). Pooled analysis demonstrated an impaired endothelial-dependent (−2.33%; 95%CI −3.30/-1.35; p < 0.001) and endothelial-independent dilation (−3.11%; 95%CI −5.14/-1.08; p = 0.003) in COPD patients when compared to non-COPD controls. Meta-regression identified that higher age, worse severity of airflow obstruction, and current smoking were significantly associated with impaired endothelial function. Studies evaluating the effects of pharmacological and non-pharmacological interventions on endothelial function in COPD patients demonstrated conflicting results.

KEYWORDS:

• COPD
• cardiovascular disease
• endothelial function
• flow-mediated dilatation
• cardiovascular risk

Article highlights

• This up-to-date review provides more evidence that patients with COPD demonstrate impaired endothelial function compared to controls without COPD.

• Both endothelial dependent and endothelial independent vasodilation are impaired, indicating that endothelial function changes in COPD are a combination of alterations in the endothelial and vascular smooth cells.

• Higher age, worse severity of airflow obstruction, and current smoking were significantly associated with impaired endothelial function in COPD.

• Various pharmacological and lifestyle interventions have tried to improve endothelial function in COPD. However, findings are conflicting, and no data are available about long-term effects.

• Considering the high burden of endothelial dysfunction in COPD and its relation with cardiovascular morbidity, more focus is needed on cardiovascular phenotyping and interventions aimed at improving endothelial function in patient with COPD.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2023.2176845

Additional information

Funding

This paper was not funded.