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Review
. 2021 Jun 28;7(2):00983-2020.
doi: 10.1183/23120541.00983-2020. eCollection 2021 Apr.

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

Marieta P Theodorakopoulou  1 , Maria Eleni Alexandrou  1 , Dimitra Rafailia Bakaloudi  1 , Georgia Pitsiou  2 , Ioannis Stanopoulos  2 , Theodoros Kontakiotis  3 , Afroditi K Boutou  4
Affiliations
Review

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

Marieta P Theodorakopoulou et al. ERJ Open Res. .

Abstract

Background: Cardiovascular disease is a major cause of morbidity and mortality in 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).

Methods: Literature search involved PubMed and Scopus databases. Eligible studies included adult patients and evaluated endothelial damage via functional methods. The 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.

Results: Of the 21 reports initially identified, 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 to -1.42) and -independent vasodilation (WMD -3.13, 95% CI -5.18 to -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 to -0.68). Subgroup analysis showed that the difference was larger when patients with COPD were compared with nonsmoking controls (SMD -1.75, 95% CI -2.58 to -0.92). Sensitivity analyses confirmed the results.

Conclusions: Patients 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.

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Conflict of interest statement

Conflict of interest: M.P. Theodorakopoulou has nothing to disclose. Conflict of interest: M.E. Alexandrou has nothing to disclose. Conflict of interest: D.R. Bakaloudi has nothing to disclose. Conflict of interest: G. Pitsiou has nothing to disclose. Conflict of interest: I. Stanopoulos has nothing to disclose. Conflict of interest: T. Kontakiotis has nothing to disclose. Conflict of interest: A.K. Boutou has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Forest plot of the difference in a) flow-mediated dilatation (FMD%); b) reactive hyperaemia index (RHI), assessed by peripheral arterial tonometry (PAT); c) forearm blood flow (FBF) assessed by venous occlusion plethysmography (VOP); and d) reactive hyperaemia assessed using flow-mediated skin fluorescence (FMSF), among patients with COPD and non-COPD controls.
FIGURE 2
FIGURE 2
Forest plot of the difference in nitroglycerine-mediated dilatation (NMD%) among patients with COPD and non-COPD controls.
FIGURE 3
FIGURE 3
Forest plot of the difference in endothelial function among patients with COPD and non-COPD controls (all methods).
FIGURE 4
FIGURE 4
Subgroup analysis comparing endothelial function of patients with COPD with nonsmoking and smoking controls.
See this image and copyright information in PMC

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