title: Clinical significance of serum bilirubin and gamma-glutamyltransferase levels on coronary atherosclerosis assessed by multidetector computed tomography.
abstract: OBJECTIVE
  Low bilirubin and high gamma-glutamyltransferase (GGT), which are endogenous markers of oxidative stress, confer a higher risk of cardiovascular disease (CVD). We investigated associations between serum concentrations of bilirubin, GGT and coronary atherosclerosis.
  
  
  RESULTS
  A cross-sectional analysis was performed on 1520 subjects who underwent multidetector computed tomography scans. Coronary atherosclerosis was assessed by coronary artery calcium score (CACS) and obstructive coronary artery disease (OCAD), was defined as the presence of coronary artery stenosis of ≥50%. Total bilirubin (TB) level was negatively correlated with CACS and coronary stenosis whereas GGT level was positively correlated with CACS in men. However, there was no correlation between TB, GGT levels and either CACS or coronary artery stenosis in women. In a multivariate-adjusted model, TB level was inversely associated with a CACS > 100 [odds ratio (OR) per log standard deviation (SD), 0.67; 95% confidence interval (CI), 0.52-0.87], and OCAD (OR per log SD, 0.77; 95% CI, 0.62-0.95) in men. By contrast, GGT level was positively associated with a CACS > 100 (OR per log SD, 1.35; 95% CI, 1.05-1.73) but not with OCAD. Adding TB and GGT to the conventional risk factors increased predictive accuracy for CACS > 100 (net reclassification improvement index [NRI] = 13.1%, P = 0.026; integrated discrimination index [IDI] = 0.024, P = 0.001) and for OCAD (NRI = 12.6%, P = 0.026; IDI = 0.010, P = 0.013).
  
  
  CONCLUSIONS
  Low TB and high GGT levels were concomitantly associated with coronary atherosclerosis in Korean men. Future studies are needed to elucidate the causal associations of TB and GGT with CVD.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Health Promotion Center, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea.
authors.forename: H S
authors.initials: HS
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: S W
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea. Electronic address: 13900@catholic.ac.kr.
authors.forename: E S
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
authors.forename: E Y
authors.initials: EY
authors.lastname: Mo
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Health Promotion Center, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
authors.forename: S D
authors.initials: SD
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Han
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D061205:Vascular Calcification / Q000097:blood / Q000473:pathology; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase; D001663:Bilirubin
keywords: Atherosclerosis; Bilirubin; Coronary artery calcification score; Coronary artery stenosis; Gamma-glutamyltransferase