Endocan Easy-to-Use Biomarker of Endothelial Dysfunction in Hypertension

Patients with hypertension have significantly higher levels of circulating endocan, signifying endocan as an easy-to-use biomarker for identifying endothelial dysfunction (ED) in hypertension, according to findings published in Hypertension Research.

Investigators sought to compare endocan levels in patients with hypertension vs normotensive healthy control individuals.

They conducted a systematic review and meta-analysis searching Web of Science, Embase, Scopus, and PubMed databases from inception to February 2023 for studies in English investigating endocan or plasma levels in patients with hypertension. They included 20 studies (N=3130) with hypertension (mean [SD] age, 50.48 [8.45] years; 33.48% men). Conference abstracts, reviews, case reports, and commentaries were excluded, as were studies without data for concentration of endocan levels. Half of the studies were conducted in Turkey. In most studies, endocan was assessed in blood serum. In 6 studies, it was evaluated in blood plasma.

The Newcastle-Ottawa Quality Assessment Scale, used to assess the quality of the included studies, indicated all 20 studies were good or very good quality. According to Egger’s test, there is a possibility of publication bias.

Patients with hypertension vs healthy control patients presented with higher circulating endocan levels (standard mean difference [SMD], 0.91; 95% CI, 0.44-1.38; P <.01). Significant heterogeneity exists in this meta-analysis of endocan levels in hypertensive patients vs healthy controls (I²=95.43%).

In subgroup analysis removing 3 studies evaluating endocan levels in patients with hypertension with different comorbidities or special populations, there were the same statistically higher endocan levels (SMD, 1.16; 95% CI, 0.66-1.65; P <.01). Significant heterogeneity exists in analysis of endocan levels in hypertensive patients without comorbidities vs healthy control patients (I²=94.90%).

Hypertensive patients with coronary artery disease (CAD) had significantly higher serum endocan levels vs those without CAD (P <.01). Patients with hypertension and chronic kidney disease (CKD) had significantly higher endocan levels vs those who were hypertensive or normotensive without CKD (P =.002 and P <.001, respectively).

Limitations of this study include inclusion of underpowered studies, potential subgroup bias, and the inability to establish the relationship between serum endocan and various stages of hypertension.

“Overall, this systematic review and meta-analysis indicated that in hypertensive patients circulating endocan levels are significantly elevated,” the investigators wrote. “…more studies should be conducted to solidify and support this association, compare endocan concentration in different stages of the disease and its prognostic value, and identify pitfalls, including synchronous comorbidities that cause the observed association to fail to be specified.”