Clinical assessment of endothelial function in patients with chronic obstructive pulmonary disease: a systematic review with meta-analysis

Pasquale Ambrosino, Roberta Lupoli, Salvatore Iervolino, Alberto De Felice, Nicola Pappone, Antonio Storino, Matteo Nicola Dario Di Minno

Research output: Contribution to journalArticle

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Abstract

Patients with chronic obstructive pulmonary disease (COPD) have an increased cardiovascular morbidity and mortality. Flow-mediated (FMD) and nitrate-mediated dilatation (NMD) are considered non-invasive methods to assess endothelial function and surrogate markers of subclinical atherosclerosis. We performed a systematic review with meta-analysis and meta-regression to evaluate the impact of COPD on FMD and NMD. Studies were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. The random-effect method was used to take into account the variability among included studies. A total of eight studies were included in the final analysis, eight with data on FMD (334 COPD patients) and two on NMD (104 COPD patients). Compared to controls, COPD patients show a significantly lower FMD (MD -3.15%; 95% CI -4.89, -1.40; P < 0.001) and NMD (MD -3.53%; 95% CI -7.04, -0.02; P = 0.049). Sensitivity analyses substantially confirms the results. Meta-regression models show that a more severe degree of airway obstruction is associated with a more severe FMD impairment in COPD patients than in controls. Regression analyses confirm that the association between COPD and endothelial dysfunction is independent of baseline smoking status and most traditional cardiovascular risk factors. In conclusion, COPD is significantly and independently associated with endothelial dysfunction. These findings may be useful to plan adequate cardiovascular prevention strategies in this clinical setting, with particular regard to patients with a more severe disease.

Original languageEnglish
JournalInternal and Emergency Medicine
DOIs
Publication statusPublished - Sep 2017

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Chronic Obstructive Pulmonary Disease
Meta-Analysis
Nitrates
Dilatation
Airway Obstruction
PubMed
Atherosclerosis
Biomarkers
Smoking
Regression Analysis
Databases
Morbidity
Mortality

Keywords

  • Journal Article

Cite this

Clinical assessment of endothelial function in patients with chronic obstructive pulmonary disease : a systematic review with meta-analysis. / Ambrosino, Pasquale; Lupoli, Roberta; Iervolino, Salvatore; De Felice, Alberto; Pappone, Nicola; Storino, Antonio; Di Minno, Matteo Nicola Dario.

In: Internal and Emergency Medicine, 09.2017.

Research output: Contribution to journalArticle

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abstract = "Patients with chronic obstructive pulmonary disease (COPD) have an increased cardiovascular morbidity and mortality. Flow-mediated (FMD) and nitrate-mediated dilatation (NMD) are considered non-invasive methods to assess endothelial function and surrogate markers of subclinical atherosclerosis. We performed a systematic review with meta-analysis and meta-regression to evaluate the impact of COPD on FMD and NMD. Studies were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. The random-effect method was used to take into account the variability among included studies. A total of eight studies were included in the final analysis, eight with data on FMD (334 COPD patients) and two on NMD (104 COPD patients). Compared to controls, COPD patients show a significantly lower FMD (MD -3.15{\%}; 95{\%} CI -4.89, -1.40; P < 0.001) and NMD (MD -3.53{\%}; 95{\%} CI -7.04, -0.02; P = 0.049). Sensitivity analyses substantially confirms the results. Meta-regression models show that a more severe degree of airway obstruction is associated with a more severe FMD impairment in COPD patients than in controls. Regression analyses confirm that the association between COPD and endothelial dysfunction is independent of baseline smoking status and most traditional cardiovascular risk factors. In conclusion, COPD is significantly and independently associated with endothelial dysfunction. These findings may be useful to plan adequate cardiovascular prevention strategies in this clinical setting, with particular regard to patients with a more severe disease.",
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AU - De Felice, Alberto

AU - Pappone, Nicola

AU - Storino, Antonio

AU - Di Minno, Matteo Nicola Dario

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