Elevated serum bilirubin levels are inversely associated with coronary artery atherosclerosis.
BACKGROUND
Inverse correlations of high serum bilirubin with metabolic and cardiovascular disease have been suggested. However, anti-atherogenic effects of bilirubin have not been well-established in terms of the presence of plaques and stenosis identified in coronary computed tomography (CT).


METHODS
A cross-sectional study was conducted on 2862 men who were free of cardiovascular disease and underwent coronary CT as part of a routine medical screening examination. Coronary stenotic lesions were considered to be incidences of coronary atherosclerosis, and stenosis was classified as stenosis <50% or ≥50%, according to degree of stenosis.


RESULTS
The prevalences of coronary atherosclerosis and stenosis ≥50% in subjects with elevated bilirubin levels (>1.2 mg/dL) were lower than those in subjects with normal bilirubin levels (≤1.2 mg/dL) (19.9% vs. 27.9%, p < 0.001, 8.5% vs. 10.3%, p = 0.044). Bilirubin was inversely associated with total plaques (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.48-0.73 in the 4th quartile vs. 1st quartile) and calcified plaques (OR 0.60, 95% CI 0.49-0.75) in univariate analysis. After adjusting for traditional risk factors, it was found that coronary atherosclerosis (OR 0.73, 95% CI 0.56-0.94 in the 4th quartile vs. 1st quartile) and calcified plaque (OR 0.66, 95% CI 0.53-0.84) were inversely associated with the bilirubin grade in a dose-dependent manner.


CONCLUSIONS
The serum bilirubin level was inversely associated with coronary atherosclerosis and calcified plaques in a dose-dependent manner. These results suggested that serum bilirubin could be used as a protective biomarker of coronary artery disease.
Department of Internal Medicine, Healthcare Research Institute, Seoul National University, Hospital Healthcare System Gangnam Center, Seoul, South Korea. Electronic address: ksjoo55@naver.com.
Seung Joo
SJ
Kang
Donghee
D
Kim
Hyo Eun
HE
Park
Goh Eun
GE
Chung
Seung Ho
SH
Choi
Su-Yeon
SY
Choi
Whal
W
Lee
Joo Sung
JS
Kim
Sang-Heon
SH
Cho
D000368:Aged; D000886:Anthropometry; D050197:Atherosclerosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D001663:Bilirubin / Q000097:blood*; D001794:Blood Pressure; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic / Q000097:blood* / Q000473:pathology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
D001663:Bilirubin
ALT; AST; Atherosclerosis; Atherosclerotic; Bilirubin; CAC; CI; CT; Coronary stenosis; GGT; HDL; LDL; OR; Plaque; TG; alanine aminotransferase; aspartate aminotransferase; computed tomography; confidence interval; coronary artery calcification; gamma-glutamyl transpeptidase; high sensitive c-reactive protein; high-density lipoprotein; hs-CRP; low-density lipoprotein; odds ratio; triglycerides