Serum Total Bilirubin Level, Prevalent Stroke, and Stroke Outcomes: NHANES 1999–2004

Abstract

Background-Bilirubin inhibits experimental atherosclerosis, is inversely associated with carotid plaque burden, and confers neuroprotection in experimental stroke. Clinical data addressing the association of bilirubin with stroke are not available. We hypothesized that higher bilirubin levels would be associated with reduced stroke prevalence and improved stroke outcomes.

Bilirubin Is Inversely Associated With Cardiovascular Disease Among HIV‐Positive and HIV‐Negative Individuals in VACS (Veterans Aging Cohort Study)

“…Similar to the current study, others have also found an inverse relationship with stroke, in which a 0.1‐mg/dL increase resulted a 9% reduction in the odds of an event in the National Health and Nutrition Examination Survey 8. This reduction is similar to the changes seen in this study at the lower quartiles.…”

“…Bilirubin is known to have antiatherogenic properties, mediated in part by reducing oxidative stress 7, 8, 9, 10. Individuals with Gilbert syndrome have elevated levels of unconjugated bilirubin because of a defect in uridine diphosphate glucuronosyltransferase 1A1 enzyme 11.…”

Low Serum Bilirubin Level as an Independent Predictor of Stroke Incidence

“…12 Cross-sectional studies reported similar results with coronary artery disease, 13,14 peripheral vascular disease, 15,16 carotid intimal-medial thickness, 17,18 and stroke. 19 This inverse relationship of bilirubin to CVD was confirmed by meta-analysis, 20 and bilirubin has been discussed as a therapeutic target for CVD. 5,6 In a recent cross-sectional study, it was shown that total bilirubin and stroke prevalence have an inverse association in the representative national data in which higher bilirubin level was not only associated with reduced stroke prevalence but also associated with favorable stroke outcomes.…”

Relationship between Serum Bilirubin and Carotid Atherosclerosis in Hypertensive Patients

“…Furthermore, the total bilirubin level was inversely correlated with metabolic syndrome (9). Recently, Erdogan et al (10) (2,13). Antioxidative agents are known to act against the formation of atheromatous lesions in animal models and in humans (14,15 …”