Correlation between circulating vascular endothelial growth factor levels and coronary artery disease and its influence on the establishment of coronary collateral circulation: A systematic review and meta-analysis

Abstract

Background: Coronary artery disease (CAD) is the leading cause of mortality worldwide. Therefore, identification of novel diagnostic biomarkers is of great significance for the timely treatment and prevention of CADs. Recent studies have shown that vascular endothelial growth factor (VEGF) is a potential biomarker to predict the pathogenesis of CAD and formation of collateral circulation in patients with severe CAD. However, current literature is inconsistent regarding the effect of VEGF on CAD. Methods: PubMed, Web of Science, Medline, CNKI, and the Cochrane Library database were searched, and 3,249 articles were initially enrolled. Study filtration criteria: Patients with CAD are identified by angiography and collateral circulation was graded by Rentrop grading system. Case control studies or cohort studies are selected. A random-effects model was used to account for within-study and between-study heterogeneity. A heterogeneity index (I2) was used to test for heterogeneity among studies. Further, meta-regression and subgroup analysis were used to analyze the impact of confounding factors on heterogeneity. Results: The VEGF concentration was different between the CAD and healthy control groups [standardized mean difference (SMD): 0.82, 95% confidence interval (CI): 0.60–1.03] with acceptable heterogeneity (I2=44.6, P=0.094). In the group with good collateral circulation, the circulating VEGF level was higher (SMD: 0.98, 95% CI: 0.53–1.43) with significant heterogeneity (I2=89.4%, P<0.05). Subsequent analysis on heterogeneity revealed that smoking history and the types of blood samples (serum or plasma) are two factors influencing the heterogeneity. Conclusions: Circulating VEGF is a potential biomarker to predict the occurrence of CAD. In addition, the concentration of circulating VEGF in patients with severe CAD is related to the degree of collateral circulation establishment.