title: Serum bilirubin and risk of ischemic heart disease in middle-aged British men.
abstract: The possibility that low concentrations of serum bilirubin may be associated with increased risk of ischemic heart disease has been examined in a prospective study of 7685 middle-aged British men. During 11.5 years there were 737 major ischemic heart disease (IHD) events. A U-shaped relationship was observed between serum bilirubin and risk of IHD. Low bilirubin was associated with several cardiovascular risk factors, in particular smoking, low concentrations of high-density lipoprotein cholesterol, low forced expiratory volume in 1 s, and low serum albumin. The U-shaped relationship persisted even after adjusting for several risk factors. Compared with men in the lowest fifth of the distribution (bilirubin < 7 mumol/L), those in the middle range (8-9 mumol/L) showed a 30% reduction in relative risk [RR = 0.68 (95% confidence intervals 0.51-0.89)] in IHD, whereas men in the top fifth (> 12 mumol/L) showed similar risk to the lowest fifth [RR = 0.99 (95% confidence intervals 0.73-1.34)], which persisted after exclusion of men with bilirubin > 17 mumol/L. The significance of this U-shaped relationship is unclear, but it could be interpreted as support for the role of endogenous antioxidants in the etiology of IHD.
authors.affiliation: Department of Clinical Pathology, Royal Free Hospital School of Medicine, London, UK.
authors.forename: L H
authors.initials: LH
authors.lastname: Breimer
authors.forename: G
authors.initials: G
authors.lastname: Wannamethee
authors.forename: S
authors.initials: S
authors.lastname: Ebrahim
authors.forename: A G
authors.initials: AG
authors.lastname: Shaper
mesh_terms: D000328:Adult; D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood*; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood; D005541:Forced Expiratory Volume; D005878:Gilbert Disease / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012907:Smoking / Q000097:blood; D006113:United Kingdom
chemical_list: D000959:Antihypertensive Agents; D008076:Cholesterol, HDL; D012709:Serum Albumin; D002784:Cholesterol; D001663:Bilirubin