PT - JOURNAL ARTICLE AU - Marieta P. Theodorakopoulou AU - Maria Eleni Alexandrou AU - Dimitra Rafailia Bakaloudi AU - Georgia Pitsiou AU - Ioannis Stanopoulos AU - Theodoros Kontakiotis AU - Afroditi K. Boutou TI - Endothelial dysfunction in COPD: a systematic review and meta-analysis of studies using different functional assessment methods AID - 10.1183/23120541.00983-2020 DP - 2021 Apr 01 TA - ERJ Open Research PG - 00983-2020 VI - 7 IP - 2 4099 - http://openres.ersjournals.com/content/7/2/00983-2020.short 4100 - http://openres.ersjournals.com/content/7/2/00983-2020.full SO - erjor2021 Apr 01; 7 AB - Background Cardiovascular disease is a major cause of morbidity and mortality in COPD. Endothelial dysfunction is suggested to be one of the pathogenetic mechanisms involved. This is a systematic review and meta-analysis of studies using any available functional method to examine differences in endothelial function between patients with COPD and individuals without COPD (controls).Methods Literature search involved PubMed and Scopus databases. Eligible studies included adult patients and evaluated endothelial damage via functional methods. The Newcastle–Ottawa scale was applied to evaluate the quality of retrieved studies. Subgroup analyses were performed to explore heterogeneity across the studies. Funnel plots were constructed to evaluate publication bias.Results Of the 21 reports initially identified, 19 studies with a total of 968 participants were included in the final meta-analysis. A significantly impaired response in endothelium-dependent (weighted mean between-group difference (WMD) −2.59, 95% CI −3.75 to −1.42) and -independent vasodilation (WMD −3.13, 95% CI −5.18 to −1.09) was observed in patients with COPD compared to controls. When pooling all studies together, regardless of the technique used for assessment of vascular reactivity, pronounced endothelial dysfunction was observed in COPD compared to controls (standardised mean difference (SMD) −1.19, 95% CI −1.69 to −0.68). Subgroup analysis showed that the difference was larger when patients with COPD were compared with nonsmoking controls (SMD −1.75, 95% CI −2.58 to −0.92). Sensitivity analyses confirmed the results.Conclusions Patients with COPD have significantly impaired endothelial function compared to controls without COPD. Future studies should delineate the importance of endothelial dysfunction towards development of cardiovascular disease in COPD.COPD is significantly associated with endothelial dysfunction of both conduit vessels and microvasculature. This association is further strengthened when patients with COPD are compared to nonsmoking controls. https://bit.ly/2NlWLFN