A study on serum bilirubin levels in coronary artery disease patients

Authors

  • Jayanthi N. Department of Medicine, VMKVMCH, Salem, Tamil Nadu, India
  • Abhilash Kasibhatla V. S. S. R. Department of Preventive Medicine, VMKVMCH, Salem, Tamil Nadu, India
  • Shankar R. Cardiology Resident, Care Hospital, Ram nagar, Visakhapatnam, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20184753

Keywords:

Coronary artery disease, Ejection fraction, Risk factor, Serum bilirubin

Abstract

Background: The protective effect of bilirubin relates to the antioxidant property of bilirubin, which prevents lipid oxidation, especially low-density lipoprotein (LDL), and inhibits free radical-induced dam-ages. Lower serum bilirubin level has been proven to be associated with endothelium and microvascular malfunction. The aim of the present study was to assess the association between serum bilirubin levels and coronary artery disease in comparison with controls without coronary artery disease.

Methods: A cross-sectional study was conducted for a period of a one year in our medical college hospital. Patients with evidence of coronary artery disease for not more than 10 years of duration confirmed by ECG, ECHO and other previous case records were taken as cases. Controls were selected matched with age, gender and other co-morbid conditions. Total of 200 subjects were included in the study with 100 cases and 100 controls. General and systemic examination was conducted on all study subjects including laboratory investigations like complete blood count, renal function test, lipid profile, viral markers such as HBsAG, HCVIgM and liver function test which includes total bilirubin, direct and indirect, liver enzymes, albumin and globulin levels. A 12 lead ECG and a transthoracic echocardiogram was performed for all patients.

Results: The various liver function test parameters were compared between the cases and controls it was found that the serum bilirubin levels which includes total bilirubin, direct bilirubin and indirect bilirubin was found to be lower among the case group compared to the control group and this difference was found to be statistically significant (p <0.05). A perfect linear correlation between the ejection fraction and serum bilirubin levels, as the ejection fraction decreases the serum bilirubin levels was also decreasing.

Conclusions: This study showed a significant association between the reduced serum bilirubin levels and the occurrence of CAD; therefore, bilirubin level can serve as a predictive factor, together with other influential factors for identifying a person at risk of developing coronary artery disease. 

References

Hansson GK, Robertson AK, Söderberg-Nauclér C. Inflammation and atherosclerosis. Annu Rev Pathol. Mech Dis. 2006 Feb 28;1:297-329.

Louise D. Bilirubin protects against heart disease. Medical Xpress. 2012.

Mayer M. Association of serum bilirubin concentration with risk of coronary artery disease. Clin Chem. 2000 Nov 1;46(11):1723-7.

Muraca M, Fevery J. Influence of sex and sex steroids on bilirubin uridine diphosphate-glucuronosyltransferase activity of rat liver. Gastroenterol. 1984 Aug 1;87(2):308-13.

Schwertner HA, Jackson WG, Tolan G. Association of low serum concentration of bilirubin with increased risk of coronary artery disease. Clin Chem. 1994 Jan 1;40(1):18-23.

Movahed A, Iranpour D, Nabipour I, Jafari M, Akbarzadeh S, Assadi M, et al. Plasma malondialdehyde, bilirubin, homocysteine and total antioxidant capacity in patients with angiographically defined coronary artery disease. African J Biotechnol. 2012;11(13):3187-91.

Troughton JA, Woodside JV, Young IS, Arveiler D, Amouyel P, Ferrières J, et al. Bilirubin and coronary heart disease risk in the Prospective Epidemiological Study of Myocardial Infarction (PRIME). Eur J Cardiovasc Prevent Rehabilitation. 2007 Feb;14(1):79-84.

Rigato I, Ostrow JD, Tiribelli C. Bilirubin and the risk of common non-hepatic diseases. Trends Molecular Med. 2005 Jun 1;11(6):277-83.

Yamaguchi T, Terakado M, Horio F, Aoki K, Tanaka M, Nakajima H. Role of bilirubin as an antioxidant in an ischemia–reperfusion of rat liver and induction of heme oxygenase. Biochem Biophysical Res Communications. 1996 Jun 5;223(1):129-35.

Siow RC, Sato H, Mann GE. Heme oxygenase–carbon monoxide signalling pathway in atherosclerosis: anti-atherogenic actions of bilirubin and carbon monoxide?. Cardiovasc Res. 1999 Feb 1;41(2):385-94.

Stocker R, Yamamoto Y, McDonagh AF, Glazer AN, Ames BN. Bilirubin is an antioxidant of possible physiological importance. Science. 1987 Feb 27;235(4792):1043-6.

Madhavan M, Wattigney WA, Srinivasan SR, Berenson GS. Serum bilirubin distribution and its relation to cardiovascular risk in children and young adults. Atherosclerosis. 1997 May 1;131(1):107-13.

Hunt SC, Kronenberg F, Eckfeldt JH, Hopkins PN, Myers RH, Heiss G. Association of plasma bilirubin with coronary heart disease and segregation of bilirubin as a major gene trait: the NHLBI family heart study. Atherosclerosis. 2001 Feb 15;154(3):747-54.

Erdogan D, Gullu H, Yildirim E, Tok D, Kirbas I, Ciftci O, ET AL. Low serum bilirubin levels are independently and inversely related to impaired flow-mediated vasodilation and increased carotid intima-media thickness in both men and women. Atherosclerosis. 2006 Feb 1;184(2):431-7.

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, et al. Heart disease and stroke statistics-2013 update: a report from the American heart association. Circulation. 2013 Jan 1;127(1):e6-e245.

Morita T. Heme oxygenase and atherosclerosis. Arterioscler Thromb Vasc Biol. 2005;25(9):1786-95.

Neuzil J, Stocker R. Free and albumin-bound bilirubin are efficient co-antioxidants for alpha-tocopherol, inhibiting plasma and low density lipoprotein lipid peroxidation. J Bio Chem. 1994;269(24):16712-9.

Ghem C, Sarmento-Leite RE, de Quadros AS, Rossetto S, Gottschall CA. Serum bilirubin concentration in patients with an established coronary artery disease. Int Heart J. 2010;51(2):86-91.

Taban SM, Golmohammadi A, Parvizi R, Kezerlou AN, Separham A, Hosnavi Z. The relation of serum bilirubin level with coronary artery disease based on angiographic findings. Crescent J Med Biol Sci. 2015;2(4):130-4.

Novotny L, Vitek L. Inverse relationship between serum bilirubin and atherosclerosis in men: a meta-analysis of published studies. Exp Biol Med (Maywood). 2003 May;228(5):568-71.

Djoussé L, Rothman KJ, Cupples LA, Levy D, Ellison RC. Effect of serum albumin and bilirubin on the risk of myocardial infarction (the framingham offspring study). Am J Cardiol. 2003;91(4A):485-8.

Rantner B, Kollerits B, Anderwald-Stadler M, Klein-Weigel P, Gruber I, Gehringer A, et al. Association between the UGT1A1 TA-repeat polymorphism and bilirubin concentration in patients with intermittent claudication: results from the CAVASIC study. Clin Chem. 2008 May 1;54(5):851-7.

Freeman R. Hormone replacement therapy (estrogen and progesterone): is it necessary for heart disease prevention?. Preventive Cardiol. 2000 Jan;3(1):21-4.

Stocker R, Glazer AN, Ames BN. Antioxidant activity of albumin-bound bilirubin. Proceed National Academy Sci. 1987 Aug 1;84(16):5918-22.

Ishizaka N, Ishizaka Y, Takahashi E, Yamakado M, Hashimoto H. High serum bilirubin level is inversely associated with the presence of carotid plaque. Stroke. 2001 Feb 1;32(2):580-3.

Vı́tek L, Jirsa Jr M, Brodanová M, Kaláb M, Mareček Z, Danzig V, et al. Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels. Atherosclerosis. 2002 Feb 1;160(2):449-56.

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Published

2018-11-22

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Original Research Articles