title: Serum Total Bilirubin Levels Provide Additive Risk Information over the Framingham Risk Score for Identifying Asymptomatic Diabetic Patients at Higher Risk for Coronary Artery Stenosis.
abstract: BACKGROUND
  The diagnosis of coronary artery disease (CAD) is often delayed in patients with type 2 diabetes. Serum total bilirubin levels are inversely associated with CAD. However, no studies have examined whether this can be used as a biochemical marker for identifying asymptomatic diabetic patients at higher risk for having obstructive CAD.
  
  
  METHODS
  We performed a cross-sectional study of 460 consecutive asymptomatic patients with type 2 diabetes. All patients underwent coronary computed tomographic angiography, and their serum total bilirubin levels were measured. Obstructive CAD was defined as ≥50% diameter stenosis in at least one coronary artery.
  
  
  RESULTS
  Serum total bilirubin tertiles showed an inverse association with the prevalence of obstructive CAD. In multivariate logistic regression analysis, the odds ratio for the highest versus the lowest tertile of total bilirubin was 0.227 (95% confidence interval [CI], 0.130 to 0.398), and an increment of 1 µmol/L in serum total bilirubin level was associated with a 14.6% decrease in obstructive CAD after adjustment for confounding variables. Receiver operating characteristic curve analysis showed that the area under the curve for the Framingham Risk Score (FRS) plus serum total bilirubin level was 0.712 (95% CI, 0.668 to 0.753), which is significantly greater than that of the FRS alone (P=0.0028).
  
  
  CONCLUSIONS
  Serum total bilirubin level is inversely associated with obstructive CAD and provides additive risk information over the FRS. Serum total bilirubin may be helpful for identifying asymptomatic patients with type 2 diabetes who are at higher risk for obstructive CAD.
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jaechan
authors.initials: J
authors.lastname: Leem
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Koh
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Chang-Yun
authors.initials: CY
authors.lastname: Woo
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jin Sun
authors.initials: JS
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Joon-Won
authors.initials: JW
authors.lastname: Kang
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Woo Je
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Joong-Yeol
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ki-Up
authors.initials: KU
authors.lastname: Lee
keywords: Bilirubin; Coronary artery disease; Diabetes mellitus; Multidetector computed tomography