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Other measures of cardiac morbidity such as reduced left ventricular ejection fraction and increased left ventricular mass also significantly improved following low dose L-carnitine supplementation [181]

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This dysregulation is driven by environmental factors such as cigarette smoke (CS) and amplified by dysregulated expression of molecules including prostaglandin E synthase (PTGES), Hedgehog-interacting protein (HHIP), and hypoxia-inducible factor-1 (HIF-1)forming a vicious cycle of environmental damagemetabolic reprogrammingpathological progression. Aberrant glycolysis in COPD patients serves as a critical metabolic basis for airway remodeling and persistent inflammation