Direct, indirect and total bilirubin and risk of incident coronary heart disease in the Dongfeng-Tongji cohort

Lai, Xuefeng; Fang, Qin; Yang, Liangle; Chen, Xuguang; Wang, Hao; Ma, Lin; Guo, Wenting; Liu, Miao; Yang, Handong; Zhang, Ce; Li, Xiulou; Min, Xinwen; Yuan, Jing; He, Meian; Wu, Tangchun; Zhang, Xiaomin

doi:10.1080/07853890.2017.1377846

Cited by 29 publications

(44 citation statements)

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“…If the TBiL was beyond the normal range, it is most probably an indicator of liver damage, which was an important risk factor for diabetes and its complications. There were several prospective studies with large sample size including our study which have showed the protective effect of TBiL in the normal range and the harmful effect in the relative higher range for cardiovascular disease and diabetes (including its complications) [ 14 , 15 , 20 ], which confirmed the U-shaped curve of TBiL for DR in our study. This implies that in clinical practice, the previous “higher TBiL indicates lower risk of complications” was not always right.…”

Section: Discussionsupporting

confidence: 86%

The U-Shaped Association between Bilirubin and Diabetic Retinopathy Risk: A Five-Year Cohort Based on 5323 Male Diabetic Patients

Liu

Wang

2018

Journal of Diabetes Research

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Aims This study aimed at assessing the impact of baseline bilirubin (TBiL) on the incidence of diabetic retinopathy (DR) based on a five-year cohort study which consisted of 5323 Chinese male diabetic patients. Methods A cohort study based on 5323 male diabetic patients was conducted in Beijing, from 2009 to 2013. Both baseline TBiL and follow-up changes were measured. Cox proportional risk model was used to calculate the hazard ratio (HR) of TBiL for DR risk. Results During the follow-up period, there were 269 new DR cases. The incidence of five-year follow-up was 5.1% (95% CI: 4.5%~5.6%). The TBiL level of those who had diabetic retinopathy was lower than that of those without (12.51+ 1.20 mol/L and 13.11+ 1.32 μmol/L, P = 0.033). And more interestingly, along with the quintiles of baseline TBiL, there showed a U-shaped curve with DR incidence. And the RRs were 0.928 (95% CI: 0.646–1.331), 0.544 (95% CI: 0.365–0.811), 0.913 (95% CI: 0.629–1.324), and 1.035 (95% CI: 0.725–1.479) for the second, third, fourth, and fifth quintiles of baseline TBiL levels, respectively, compared with the first quintile. For follow-up TBiL changes, after being adjusted for related covariables and baseline TBiL levels (as continuous variable) in the model, the RRs for DR were 1.411 (95% CI: 1.081–1.842) for those who had decreased TBiL level and 0.858 (95% CI: 0.770–0.947) for those who had increased TBiL level during follow-up. And this association was more prominent among those with lower baseline TBiL level. Conclusions Serum TBiL had a U-shaped relationship with DR incidence, which was independent of control status of diabetes and other related covariates.

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Section: Discussionsupporting

confidence: 86%

The U-Shaped Association between Bilirubin and Diabetic Retinopathy Risk: A Five-Year Cohort Based on 5323 Male Diabetic Patients

Liu

Wang

2018

Journal of Diabetes Research

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“…In the present study, we also found DB was inversely correlated with LVEF. In another study, 22 DB was reported to be associated with increased incidence of coronary heart disease in a dose-response manner in Chinese patients. Likewise, other 2 studies also demonstrated that elevated DB could predict adverse events of acute compensated heart failure 23 and idiopathic pulmonary arterial hypertension.…”

Section: Discussionmentioning

confidence: 91%

Relation of Direct, Indirect, and Total bilirubin to Adverse Long-term Outcomes Among Patients With Acute Coronary Syndrome

Dong

Deng

et al. 2019

The American Journal of Cardiology

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Bilirubin is known as an antioxidant. However, there have been controversies over whether bilirubin is protective against cardiovascular disease or not. In addition, no study has examined the association between subtypes of total bilirubin (direct bilirubin [DB] and indirect bilirubin [IDB]) and long-term outcomes of acute coronary syndrome (ACS) patients. We included 533 consecutive patients with ACS. All the patients were followed up for the composite end point of cardiac death, revascularization, and acute heart failure. At a median follow-up of 2.4 years, Kaplan-Meier curve demonstrated that higher serum DB levels were significantly associated with major adverse cardiac events (MACE) (p <0.05). However, total bilirubin (TB) and IDB were not associated with MACE by Kaplan-Meier analysis. Cox analysis showed that high TB and DB were associated with increased risk of MACE in ACS even after adjustment of cardiovascular risk factors. The receiver operating characteristic curve illustrated that DB had a predictive value of MACE in ACS. In conclusion, we firstly reported that high TB and DB but not IDB were associated with increased risk of MACE in Chinese ACS, and the prognostic value of DB was superior to that of TB or IDB.

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“…Вміст білірубіну збільшується переважно за умов уражень печінки, однак, значення його рівня в організмі є набагато ширшим, що останнім часом привернуло увагу науковців [1][2][3][4][5]. Зокрема, виявлено зв'язки концентрації загального білірубіну з ризиком ішемічної хвороби серця (ІХС) [6], швидкістю клубочкової фільтрації та розвитком ретинопатії чи нейропатії при цукровому діабеті (ЦД) [4,7], іншими судинними ураженнями [2,8], атеросклерозом [5] Стан проблеми. Жовчний пігмент білірубін утворюється внаслідок розщеплення білків, які містять гем (гемоглобін, цитохром, метгемогло-бін) у ретикулярно-макрофагальних клітинах печінки, кісткового мозку, селезінки та лімфатичних вузлів під впливом ферменту білівердин-редуктази.…”

Section: вступunclassified

“…Також описана обернена кореляція рівня ЗБ з артеріальною жорсткістю [8]. Усе наведене стосується не лише ЗБ, а й прямого білірубіну, який також був пов'язаним з кардіоваскулярним ризиком [6], у тому числі у пацієнтів з ЦД [16].…”

Section: вступunclassified

“…Незважаючи на те, що білірубін вже визнано маркером активності окисного стресу, і, відповідно, кардіоваскулярного ризику, використання його у цій ролі у реальних клінічних умовах не отримало розповсюдження, що може бути зумовлено нелінійним характером таких взаємодій. За сучасними уявленнями, вміст ЗБ та кардіоваскулярний ризик мають U-подібну залежність [6].…”

Section: вступunclassified

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Decrease in Serum Bilirubin as an Unfavorable Marker of Cardiovascular Disorders

Strilchuk

Zimba

Zhakun

2020

EUMJ

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Serum bilirubin, the end product of heme metabolism, is a routine biochemical parameter. Bilirubin is not a liver function parameter exclusively: its concentration correlates with ischemic heart disease (IHD) risk, estimated glomerular filtration rate, retinopathy or neuropathy in diabetes mellitus, atherosclerosis etc. The aim of this paper was to estimate the clinical value of bilirubin analysis according to literature data and own clinical observations in patients with IHD and acute and chronic rheumatologic diseases. Materials and methods. We conducted a literature overview in Pubmed database and domestic sources and also analyzed the standard examinaions of 515 patients: 353 patients with coronary heart disease (acute forms, coronary bypass grafting – 98; acute myocardial infarction, pharmacotherapy – 75; unstable angina pectoris – 101; stable angina pectoris – 79) and 162 rheumatologic patients (haemorrhagic vasculitis – 71; rheumatic fever – 57; chronic rheumatic heart disease with valvular defects – 34). Control group consisted of 22 patients with gastroduodenal zone diseases without helicobacter (esophagitis, gastritis, peptic ulcer). Results and discussion. It was revealed that in case of diseases with oxidative stress in their pathogenesis (acute forms of coronary heart disease, haemorrhagic vasculitis, rheumatic fever) bilirubin level was lower than in case of non-oxidative disorders (non-infectious esophagitis, gastritis, ulcer). Increase of inflammation potency was accompanied by bilirubin decrease. Correlation analysis showed that both bilirubin increase and decrease were unfavourable. Conclusions. Bilirubin concentration correlated with parameters of cytolysis, intoxication, anemia, inflammation, carbohydrate and lipid metabolism, heart structure. Bilirubin decrease associated with the increase of stenosis of coronary arteries (left, left circumflex and anterior interventricular) in a logarithmic way. Hypobilirubinemia (< 9.6 mkmol/L) significantly more often accompanied diseases with oxidative stress in pathogenesis, acute forms and more active systemic inflammation. Keywords total bilirubin, hypobilirubinemia, coronary heart disease, haemorrhagic vasculitis, rheumatic fever, chronic rheumatic heart disease.

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Direct, indirect and total bilirubin and risk of incident coronary heart disease in the Dongfeng-Tongji cohort

Cited by 29 publications

References 37 publications

The U-Shaped Association between Bilirubin and Diabetic Retinopathy Risk: A Five-Year Cohort Based on 5323 Male Diabetic Patients

The U-Shaped Association between Bilirubin and Diabetic Retinopathy Risk: A Five-Year Cohort Based on 5323 Male Diabetic Patients

Relation of Direct, Indirect, and Total bilirubin to Adverse Long-term Outcomes Among Patients With Acute Coronary Syndrome

Decrease in Serum Bilirubin as an Unfavorable Marker of Cardiovascular Disorders

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