Endothelial dysfunction in COPD: a systematic review and meta-analysis of studies using different functional assessment methods

Abstract

BackgroundCardiovascular disease is a major cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Endothelial dysfunction is suggested to be one of the pathogenetic mechanisms involved. This is a systematic review and meta-analysis of studies using any available functional method to examine differences in endothelial function between patients with COPD and individuals without COPD (controls).MethodsLiterature search involved PubMed and Scopus databases. Eligible studies included adult patients and evaluated endothelial damage via functional methods. Newcastle-Ottawa Scale was applied to evaluate the quality of retrieved studies. Subgroup analyses were performed to explore heterogeneity across the studies. Funnel-plots were constructed to evaluate publication bias.ResultsOf the 21 initially identified reports, 19 studies with a total of 968 participants were included in the final meta-analysis. A significantly impaired response in endothelium-dependent (weighted mean between-group difference, WMD: −2.59%, 95%CI [−3.75, −1.42]) and –independent vasodilation (WMD: −3.13, 95%CI [−5.18, −1.09]) was observed in patients with COPD compared to controls. When pooling all studies together, regardless of the technique used for assessment of vascular reactivity, pronounced endothelial dysfunction was observed in COPD compared to controls (standardised-mean-difference, SMD: −1.19, 95%CI [−1.69, −0.68]). Subgroup analysis showed that the difference was larger when patients with COPD were compared with non-smoking controls (SMD: −1.75, 95%CI [−2.58, −0.92]. Sensitivity analyses confirmed the above results.ConclusionsPatients with COPD have significantly impaired endothelial function compared to controls without COPD. Future studies should delineate the importance of endothelial dysfunction towards development of cardiovascular disease in COPD.

Blood CDC42 overexpression is associated with an increased risk of acute exacerbation, inflammation and disease severity in patients with chronic obstructive pulmonary disease

“…Therefore, CDC42 expression may be increased in patients with COPD due to an as yet unknown compensatory mechanism. In addition, patients with AE-COPD typically experienced longer disease durations compared with those in patients with stable COPD, such that prolonged disease may enhance endothelial dysfunction and disease severity ( 24 ). Since CDC42 has been demonstrated to exert a protective effect against endothelial injury, CDC42 expression was higher in patients with AE-COPD compared with that in patients with S-COPD.…”

Analysis of pathogenesis and drug treatment of chronic obstructive pulmonary disease complicated with cardiovascular disease

“…It has been found that NO-mediated endothelial relaxation in COPD patients is present early in the disease and is associated with airflow obstruction (61). The results of multiple meta-analyses have also confirmed that COPD endothelial function is impaired, and the severity is positively correlated with the degree of airway obstruction (62)(63)(64). Endothelial dysfunction in COPD may be involved in the following aspects ( 65 (5) Antioxidant Pathway activation decreased; (6) NO release decreased, endothelin-1 expression increased and so on.…”

New treatment options for a patient with chronic heart failure and chronic obstructive pulmonary disease

“…Дисбаланс между вазодилататорами и вазоконстрикторами (увеличение ЭТ-1, снижение концентрации NO в крови), изменения сосудистого русла непосредственно в бронхиальной стенке вносят значимый вклад в формирование необратимой бронхиальной обструкции и хронической легочной гипертензии [23][24][25].…”