The Effects of Ischemic Preconditioning Supplementation on Endothelial Function: A Systematic Review and Meta-Analysis

Abstract

Objective. Ischemic preconditioning (IPC) has gradually been promoted in clinical practice to lower the risk of cardiovascular surgery and postoperative complications. We investigated the role of IPC on vascular endothelial function and the relationship between IPC, flow-mediated dilation (FMD), and brachial artery diameter (BAD). Methods. Systematic searches were conducted in PubMed, Medline, Cochrane Library, Embase, and Scopus databases from their inception to March 20, 2020. This research included randomized controlled trials (RCTs) with adults, and the values of FMD and BAD were considered as the primary outcomes. Ten studies comprising 292 participants were included in the meta-analysis. Results. Regarding FMD, we observed beneficial effects of IPC on endothelial function (standardized mean difference (SMD): 1.82; 95% confidence interval (CI): 0.64, 3.01; p < 0.001 ; I2 = 89.9%). However, the available evidence did not indicate that IPC affected BAD (SMD: 0.08; 95% CI: −0.03, 0.18; p > 0.05 ; I2 = 76.5%). Conclusions. Our meta-analysis indicated a significant effect of IPC on the endothelial function of the blood vessels, affecting FMD but not BAD.

Potential physiological responses contributing to the ergogenic effects of acute ischemic preconditioning during exercise: A narrative review

“…IPC has been shown to acutely affect peripheral vascular responses such as enhanced conduit artery vasodilation, endothelial function, convective O 2 delivery, and deoxygenation kinetics at the muscle capillary interface ( Loukogeorgakis et al, 2005 ; Enko et al, 2011 ; Paradis-Deschênes et al, 2016 ; Cocking et al, 2018a ). The reader is directed to the following references for associated details of each of these phenomena ( Pagliaro et al, 2003 ; Luca et al, 2013 ; Paradis-Deschênes et al, 2016 , 2017 ; Cocking et al, 2018a ; Gu et al, 2021 ).…”

“…Indeed, evidence supports the above theory of local vasodilatory responses to IPC. A recent systematic review and meta-analysis by Gu et al (2021) investigated the role of arm IPC on resting vascular endothelial function and the relationship between IPC, FMD, and brachial artery diameter. That review concluded that there are beneficial effects of IPC on endothelial function of the blood vessels by enhancing FMD.…”

“…Taken together, a growing body of evidence summarized in Supplementary Table S1 suggests that peripheral vascular and hemodynamic responses may contribute to the ergogenic responses observed following local and remote IPC. These responses are likely mediated by several known vasoactive mechanisms such as shear mediated dilation ( Gu et al, 2021 ), neuronally mediated vasodilation ( Manchurov et al, 2014 ), reactive hyperemia ( Rosenberry and Nelson, 2020 ), and increased extraction of O 2 at the muscle-capillary interface ( Paradis-Deschênes et al, 2016 ). Curiously, these effects are not always observed, which may be partly attributable to methodological variations between study protocols or may infer the existence of IPC non-responders ( O’Brien and Jacobs, 2021 ).…”

“…Previously, IPC has been demonstrated to have protective properties against the injurious effects of ischemia-reperfusion injury in mammalian animal models ( Pérez-Pinzón, 2004 ; Konstantinov et al, 2005 ; Kristiansen et al, 2005 ; Wang et al, 2016 ) and has been shown in humans to improve various clinical outcomes such as protection against post-ischemia-reperfusion endothelial dysfunction, and post-surgical acute kidney injury, among others ( Luca et al, 2013 ; Khaliulin et al, 2019 ; Gu et al, 2021 ; Liu et al, 2021 ). In sport and exercise research literature, IPC has been repeatedly reported to improve athletic performance using a variety of maximal exercise intensities and modalities such as running, swimming, or cycling lasting from about 30 s to 20 min ( Jean-St-Michel et al, 2011 ; Bailey et al, 2012b ; Cruz et al, 2015 , 2016 ; Kraus et al, 2015 ; Cocking et al, 2018b ; Paradis-Deschênes et al, 2018 ).…”

The effects of lower limb ischaemic preconditioning: a systematic review

“…However, the haemoglobin responses vary considerably for IPC ( Paradis-Deschenes et al, 2017 ; Jeffries et al, 2019 ; Huang et al, 2020 ), highlighting the large variability in the existing research. The increase in blood flow following the reperfusion during the IPC manoeuvre results in an increase in shear stress in the endothelium ( Gu et al, 2021 ). Shear stress acts as a stimulus for the release of nitric oxide (NO) from endothelium nitric oxide synthase (eNOS) ( Lang and Kim, 2022 ), with repeated exposure resulting in an increase eNOS transcription and a greater bioavailability of NO ( Hunt et al, 2013 ).…”