Global Insights into the Impact of Endothelial Dysfunction on Coronary Artery Disease: A Systematic Review.

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.