Endothelial function in patients with COPD: an updated systematic review of studies using flow-mediated dilatation
Related Experiment Video
Updated: Aug 11, 2025
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Anouk W Vaes1, Patrick De Boever2, Frits M E Franssen1,3,4
1Department of Research and Development, Ciro, Horn, Netherlands.
Insights
Cardiovascular disease is common in COPD. This review found impaired endothelial function in COPD patients, linked to age, airflow obstruction severity, and smoking. Interventions showed mixed results.
Area of Science:
- Cardiology
- Pulmonology
- Vascular Biology
Background:
- Cardiovascular disease (CVD) is a major cause of death in patients with chronic obstructive pulmonary disease (COPD).
- Endothelial dysfunction is a proposed mechanism linking COPD and CVD.
- Previous studies indicate endothelial dysfunction in COPD patients.
Purpose of the Study:
- To summarize current knowledge on endothelial function in COPD patients.
- To meta-analyze studies assessing endothelial function in COPD using flow-mediated dilation.
- To identify factors associated with endothelial dysfunction in COPD.
Main Methods:
- Systematic literature search of studies published until November 2022.
- Meta-analysis of ultrasound-based flow-mediated dilation data from COPD patients and controls.
- Meta-regression to explore associations between clinical variables and endothelial function.
Main Results:
- 34 studies involving 1365 COPD patients and 617 controls were analyzed.
- COPD patients exhibited significantly impaired endothelial-dependent and independent dilation compared to controls.
- Higher age, worse airflow obstruction, and current smoking were associated with poorer endothelial function.
Conclusions:
- Endothelial dysfunction is a significant finding in COPD patients.
- Age, disease severity, and smoking status are key factors influencing endothelial function in COPD.
- Current evidence on interventions to improve endothelial function in COPD is conflicting.
Introduction:
Cardiovascular disease is a significant cause of morbidity and mortality in COPD. Endothelial dysfunction is suggested to be involved in cardiovascular disease pathogenesis, and multiple studies report endothelial dysfunction in COPD. This article summarized the current knowledge on endothelial function in COPD patients.
Areas Covered:
Databases were screened until November 2022 for studies using ultrasound-based flow-mediated dilation in patients with stable COPD. Pooled effect sizes were calculated using random effects model. Meta-regression analyses assessed the effects of demographic and clinical variables.
Expert Opinion:
34 studies were identified (1365 COPD patients; 617 controls). Pooled analysis demonstrated an impaired endothelial-dependent (-2.33%; 95%CI -3.30/-1.35; p < 0.001) and endothelial-independent dilation (-3.11%; 95%CI -5.14/-1.08; p = 0.003) in COPD patients when compared to non-COPD controls. Meta-regression identified that higher age, worse severity of airflow obstruction, and current smoking were significantly associated with impaired endothelial function. Studies evaluating the effects of pharmacological and non-pharmacological interventions on endothelial function in COPD patients demonstrated conflicting results.
Related Concept Videos
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:20Chronic Obstructive Pulmonary Disease-I: Introduction
01:22Chronic Obstructive Pulmonary Disease
Smoking is a primary risk factor for COPD, with over 80% of patients having a history of it. Patients typically experience progressive dyspnea or labored breathing, frequent coughing, and recurrent pulmonary infections. Many eventually succumb to respiratory failure, characterized by...
01:20Chronic Obstructive Pulmonary Disease-II: Pathophysiology
Chronic Inflammation
01:20COPD: Pathogenesis and Clinical Features
The primary cause for the onset of COPD is cigarette smoking and exposure to air pollution. These hazardous factors initiate a chain reaction within the lungs, resulting in chronic inflammation, damage to the airways, and a...
01:25Chronic Obstructive Pulmonary Disease-III: Symptoms and Complications.
Symptoms of COPD can be classified as primary or systemic. Primary symptoms relate to reduced airflow, while systemic or extrapulmonary symptoms relate to COPD's broader impact on the body.
Primary Symptoms of COPD: