Differential impact of serum total bilirubin level on cerebral atherosclerosis and cerebral small vessel disease.
BACKGROUND
A low serum total bilirubin (T-bil) level is associated with an increased risk of atherosclerosis. However, the differential impact of the serum T-bil level on cerebral atherosclerosis and cerebral small vessel disease (SVD) is still unclear.


METHODS
We evaluated serum T-bil levels from 1,128 neurologically healthy subjects. Indices of cerebral atherosclerosis (extracranial arterial stenosis [ECAS] and intracranial arterial stenosis [ICAS]), and indices of SVD (silent lacunar infarct [SLI], and moderate-to-severe white matter hyperintensities [msWMH]) were evaluated by the use of brain magnetic resonance imaging (MRI) and MR angiography.


RESULTS
In logistic regression analysis after adjusting for confounding variables, subjects within middle T-bil (odds ratio [OR]: 0.63; 95% CI: 0.41-0.97) and high T-bil tertiles (OR: 0.54; 95% CI: 0.33-0.86) showed a lower prevalence of ECAS than those in a low T-bil tertile. Although subjects with a high T-bil tertile had a lower prevalence of ICAS than those with a low T-bil tertile, the statistical significance was marginal after adjusting for confounding variables. There were no significant differences in the proportions of subjects with SLI and msWMH across serum T-bil tertile groups.


CONCLUSIONS
The serum T-bil level is negatively associated with cerebral atherosclerosis, especially extracranial atherosclerosis, but not with SVD.
Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Jonguk
J
Kim
Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Seung-Jae
SJ
Yoon
Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Min-Hee
MH
Woo
Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Sang-Heum
SH
Kim
Institute for Clinical Research, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Nam-Keun
NK
Kim
Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Jinkwon
J
Kim
Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Ok-Joon
OJ
Kim
Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Seung-Hun
SH
Oh
D000368:Aged; D001663:Bilirubin / Q000097:blood*; D059345:Cerebral Small Vessel Diseases / Q000097:blood*; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000097:blood*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D001663:Bilirubin