Decreased Serum Bilirubin Is Associated With Silent Cerebral Infarction

Abstract

946S ilent cerebral infarction (SCI) is a cerebral infarction that is evident on brain imaging but is not associated with a clinical symptom. In most cases, SCI is found as a lacunar infarction, that is, a small, deep cerebral infarct caused by occlusion of small penetrating cerebral arteries. Recent studies demonstrated that the presence of SCI predicts transient ischemia attack, clinically overt stroke, cardiovascular disease, and dementia. 1-3 See accompanying editorial on page 702A large body of evidence has highlighted a role for oxidative stress in atherosclerosis. Oxidative stress is induced by increased production of reactive oxygen species or decreased antioxidant capacity of endogenous antioxidant systems. Bilirubin is an effective antioxidant molecule that suppresses the oxidation of lipids and prevents the formation of plaque. 4 In several cross-sectional studies, bilirubin levels were found to be decreased in carotid intima-media thickness, cardiovascular disease, stroke, and peripheral arterial disease.5-8 A meta-analysis further confirmed that bilirubin levels were reduced in coronary artery disease. 9 To the best of our knowledge, the relationship between bilirubin levels and SCI has not yet been reported. We, therefore, conducted this study to assess the bilirubin levels in general population. Materials and MethodsMaterials and Methods are available in the online-only Supplement. ResultsClinical and laboratory data of participants with and without SCI are shown in Table 1. Of the 2865 participants enrolled, 1831 (63.91%) were men and 1034 (36.09%) were women. Median (interquartile range) of total bilirubin (TB) concentration was 10.5 (7.8-13.8; range, 2.1-33.4) μmol/L in the whole cohort of individuals. Three hundred forty-three participants (11.97%; 274 men and 69 women) presented SCI. The patients with SCI were older and had higher body mass index (BMI), systolic blood pressure, diastolic blood pressure (DBP), total cholesterol (TC), triglyceride, low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), and brachial-ankle pulse wave velocity (baPWV) levels and reduced TB, indirect bilirubin, direct bilirubin, estimated glomerular filtration rate (eGFR), and high-density lipoprotein cholesterol levels compared with the subjects without SCI. However, the levels of aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, and current use of statins and calcium channel blocker drugs in the 2 groups had no difference. Male sex, smoking, alcohol consumption, type 2 diabetes mellitus (DM), hypertension, and current use of angiotensin-converting enzyme inhibitor/angiotensin II receptor antagonist, aspirin, and hypoglycemic drugs had a higher prevalence in SCI group.The demographic and biochemical characteristics of the study population according to TB quartiles are shown in Table 2 FPG, triglyceride, LDL-C, FPG, aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, and baPWV decreased gradually as TB increased. Also, the percentage ...

Higher Level of Serum Heme Oxygenase-1 in Patients With Intracerebral Hemorrhage

“…Multivariate logistic regression analysis revealed that higher total bilirubin was associated with a lower risk of silent cerebral infarction. 15 However, the bilirubin level in our ICH patients was higher than in control patients, and the discrepancy between our studies with above statement could be due to the bias caused by a limited number of our patients.…”

Risk of Ischemic Stroke and Decreased Serum Bilirubin Levels

“…19,20 Collectively, the evidence from this 18 and other studies [11][12][13][14][15][16][17] supports the possibility that the early measurement of TB levels might be useful to assess the risk of silent cerebral infarction(s) and major stroke and that mildly elevated TB levels might protect from stroke events and from neurological damage in stroke.…”

“…In this scenario, the study published by Li et al 18 in this issue of the journal adds to the body of evidence showing, for the first time, a graded, inverse relationship between serum levels of TB (conjugated and unconjugated bilirubin) and increased prevalence of silent cerebral infarctions in middle-aged Chinese individuals. Notably, this relationship remained significant after adjusting for established stroke risk factors and potential confounders.…”

Neutrophil–Lymphocyte ratio is associated with arterial stiffness in diabetic retinopathy in type 2 diabetes

“…All measurements were conducted by a single examiner who was blinded to the clinical data. The reproducibility and validity of the baPWV measurement using this method has been previously demonstrated (Li, Cao, Zhang, Li, andWang, 2014, Li, Meng, Meng, Yu, andWang, 2011).…”