Endothelial function in patients with chronic obstructive pulmonary disease: a systematic review of studies using flow mediated dilatation

Abstract

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.

Associations between lung and endothelial function in early middle age

“…The difference in strength of associations between the sexes was unexpected. It is not known whether this sex difference would be found in older cohorts or those with established lung or cardiovascular disease: most previous reports on associations between endothelial function and respiratory diseases comprise relatively smaller samples of older men and women and, as far as we are aware, none have investigated sex differences . We can only speculate on the reasons for this effect modification by sex.…”

“…It is not known whether this sex difference would be found in older cohorts or those with established lung or cardiovascular disease: most previous reports on associations between endothelial function and respiratory diseases comprise relatively smaller samples of older men and women and, as far as we are aware, none have investigated sex differences. 2,[6][7][8][9][10][11][12][13] We can only speculate on the reasons for this effect modification by sex. There are established, but poorly understood, sex differences in the associations between lung function and other systemic conditions: previous research in this cohort has identified several sex interactions between lung function and non-respiratory health.…”

“…Non‐invasive measures of endothelial function predict the risk of future cardiovascular events . Impaired endothelial function has been reported in both COPD and asthma, and the extent of endothelial dysfunction is associated with the severity of airflow obstruction . Assessing the pulmonary endothelium is difficult, but it has been suggested that airway inflammation causes endothelial dysfunction in the pulmonary circulation, which leads to systemic endothelial dysfunction .…”

“…4,5 Impaired endothelial function has been reported in both COPD and asthma, and the extent of endothelial dysfunction is associated with the severity of airflow obstruction. 2,[6][7][8][9][10][11][12][13] Assessing the pulmonary endothelium is difficult, but it has been suggested that airway inflammation causes endothelial dysfunction in the pulmonary circulation, which leads to systemic endothelial dysfunction. 7 Conversely, it is possible that cardiovascular disease causes systemic and pulmonary endothelial dysfunction and thereby influences lung function.…”

Endothelial dysfunction is not a predictor of outcome in chronic obstructive pulmonary disease

“…In addition, the discrepancies in the findings may be attributed to the fact that: 1) our study only excluded COPD patients with other pulmonary conditions, rapid lethal disease and severe immunosuppression and therefore affords a more reasonable representation of the general COPD population, while, on the other hand, Malerba et al [33] excluded patients with a history of any cardiovascular disease except arterial hypertension, diabetes mellitus and if the patient had an exacerbation in the previous 6months; and 2) in the study of Malerba et al [33], patients had less severe COPD than the patients in our study. In a number of studies, both FMD and RHI are lower in COPD patients than in controls, but the association with COPD parameters is tenuous [45,46]. Eickhoff et al [10] found an association between FMD and FEV 1 % predicted in a univariate analysis, but no significant association between FMD and GOLD status.…”