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Global Insights into the Impact of Endothelial Dysfunction on Coronary Artery Disease: A Systematic Review
A Ismail1, K Isyaku1, M U Sani2
1Department of Radiology, Faculty of Clinical Sciences, Bayero University, Kano, Nigeria. Email: aismail.rad@buk.edu.ng; Telephone: +2348039275786.
Insights
Endothelial dysfunction is key in coronary artery disease (CAD) progression. Assessing endothelial function aids in CAD risk assessment, early detection, and treatment decisions.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Public Health
Background:
- Coronary artery disease (CAD) poses a significant global health challenge, particularly in low- and middle-income countries (LMICs).
- Vascular endothelial dysfunction is a critical factor in the advancement of CAD.
Purpose of the Study:
- To systematically review and evaluate the existing literature on the role of endothelial dysfunction in the progression of coronary artery disease.
Main Methods:
- A systematic review protocol was registered with PROSPERO (CRD42024539722).
- A comprehensive literature search yielded 70 articles; after deduplication and screening, 15 studies involving 3,673 subjects were included.
- Included studies spanned 1998-2023, comprising 9 cross-sectional, 5 cohort, and 1 retrospective design.
Main Results:
- Endothelial dysfunction was linked to CAD severity in five studies.
- Cohort studies indicated that endothelial dysfunction can predict adverse cardiovascular events, even in cases with normal angiograms.
- Flow-mediated dilation (FMD) was a common method for assessing endothelial function.
Conclusions:
- Endothelial function plays a crucial role in CAD.
- Evaluating endothelial function is vital for risk stratification, early diagnosis, and guiding therapeutic strategies in patients with CAD.
Background:
Coronary artery disease (CAD) is a major global health issue, especially in low- and middle-income countries (LMICs). The dysfunction of the vascular endothelium plays a critical role in CAD progression.
Objectives:
This systematic review evaluated existing literature on the role of endothelial dysfunction in the progression of CAD.
Methods:
The review protocol was registered with PROSPERO (CRD42024539722). A comprehensive literature search identified 70 relevant articles. After removing 15 duplicates, 55 studies were screened based on title and abstract, leading to the exclusion of 35 articles that did not meet the inclusion criteria. Finally, 15 studies, encompassing a total of 3,673 subjects (with individual study sample sizes ranging from 14 to 936, and a median of 106), were included in the review.
Results:
The 15 studies (3,673 subjects, 1998-2023) included 9 cross-sectional, 5 cohort, and 1 retrospective study. CAD diagnosis was confirmed via angiography (10 studies) or other methods like stress ECG and cardiac enzymes. Endothelial dysfunction was assessed using FMD (8 studies) and other techniques. Five studies linked endothelial dysfunction to CAD severity, while cohort studies suggested its role in predicting adverse cardiovascular events, even with normal angiograms.
Conclusion:
This systematic review highlights the crucial role of endothelial function in CAD and emphasizes the importance of endothelial function in risk assessment, early detection, and guiding treatment decisions in CAD.
