Anouk W Vaes1,2, Martijn A Spruit1,3,4, Jan Theunis2, Nandu Goswami5, Lowie E Vanfleteren1,4, Frits M E Franssen1,4, Emiel F M Wouters1,4, Patrick De Boever2,6. 1. a Department of Research and Education , Ciro , Horn , Netherlands. 2. b Environmental Risk and Health Unit , Flemish Institute for Technological Research (VITO) , Mol , Belgium. 3. c Department of Respiratory Medicine , Maastricht University Medical Centre (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism , Maastricht , The Netherlands. 4. d REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium. 5. e Department of Physiology , Medical University of Graz , Graz , Austria. 6. f Centre for Environmental Sciences , Hasselt University , Hasselt , Belgium.
Abstract
BACKGROUND: Cardiovascular disease is an important cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Endothelial function may be involved in the pathogenesis of cardiovascular disease. In contrast to the attention given to pulmonary endothelial dysfunction, little is known about peripheral vascular changes in COPD. Therefore, we reviewed the literature on peripheral endothelial function in COPD. METHODS: Databases were screened for studies using ultrasound-based flow-mediated dilation (FMD), the reference method for assessing peripheral endothelial function, in stable COPD patients. Pooled effect sizes were calculated using random effects model. RESULTS: 17 studies were identified, with a total of 1228 participants (724 COPD patients; 504 controls). Pooled analysis demonstrated an impaired endothelial-dependent FMD (-3.22%; 95% confidence interval (CI) -4.74 to -1.69; p < 0.001; I2 = 96%) and endothelial-independent FMD (-2.86%; 95%CI -5.63 to -0.09; p = 0.04; I2 = 83%) in COPD patients when compared with smoking and non-smoking controls. CONCLUSION: This review provides evidence for impaired peripheral endothelial function in COPD. Since impaired endothelial function may contribute to cardiovascular morbidity, a more comprehensive cardiovascular phenotyping is considered important in COPD to address cardiovascular risk. A high frequency of cardiovascular comorbidity is observed in COPD patients, and therefore well-controlled, larger studies that investigate endothelial function in COPD patients are recommended.
BACKGROUND:Cardiovascular disease is an important cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Endothelial function may be involved in the pathogenesis of cardiovascular disease. In contrast to the attention given to pulmonary endothelial dysfunction, little is known about peripheral vascular changes in COPD. Therefore, we reviewed the literature on peripheral endothelial function in COPD. METHODS: Databases were screened for studies using ultrasound-based flow-mediated dilation (FMD), the reference method for assessing peripheral endothelial function, in stable COPDpatients. Pooled effect sizes were calculated using random effects model. RESULTS: 17 studies were identified, with a total of 1228 participants (724 COPDpatients; 504 controls). Pooled analysis demonstrated an impaired endothelial-dependent FMD (-3.22%; 95% confidence interval (CI) -4.74 to -1.69; p < 0.001; I2 = 96%) and endothelial-independent FMD (-2.86%; 95%CI -5.63 to -0.09; p = 0.04; I2 = 83%) in COPDpatients when compared with smoking and non-smoking controls. CONCLUSION: This review provides evidence for impaired peripheral endothelial function in COPD. Since impaired endothelial function may contribute to cardiovascular morbidity, a more comprehensive cardiovascular phenotyping is considered important in COPD to address cardiovascular risk. A high frequency of cardiovascular comorbidity is observed in COPDpatients, and therefore well-controlled, larger studies that investigate endothelial function in COPDpatients are recommended.
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