DOI: http://dx.doi.org/10.18203/2349-3933.ijam20212109

Association of total bilirubin levels with acute coronary syndrome and other risk factors: an observational study

Shubhangi Verma, Omkar Kamble

Abstract


Background: Acute coronary syndrome (ACS) refers to clinical symptoms pertaining to acute myocardial infarction. Bilirubin is an antioxidant that helps in removal of excessive heme. The aim of the study was to find the association of ACS and other risk factors for ACS with the total bilirubin levels in our setup.

Methods: A cross sectional observational study was conducted on 100 cases attending the department of medicine in a Dr. Panjabrao Deshmukh Memorial Medical College, Amravati, Maharashtra. Patients fitting the eligibility criteria were subjected to data collection which was done using pre-designed case record form. The case record form had details of demography, detailed clinical history, physical examination and relevant investigations.

Results: The mean age of the cases was 55.64±10.23 years with male preponderance. Majority of the patients presented with chest pain (83%) followed by shortness of breath (65%) and nausea/vomiting (33%). There was moderate significant correlation between total bilirubin levels and LDL levels (r=0.703; p value<0.001) and There was mild significant correlation between total bilirubin levels and TGs (r=0.403, p value<0.001) Based on the median value of 0.48 as cut off, 33% had bilirubin levels more than 0.48. Presence of diabetes and hyperlipidemias had significant association with the total bilirubin levels.

Conclusions: Nearly 1/3rd of the patients in our study had high bilirubin levels. Higher bilirubin levels correlated well with presence of diabetes and presence of hyperlipidemias.  There was significant correlation between the serum LDL and TG levels with total bilirubin levels in the present study.


Keywords


Acute myocardial infarction, Total bilirubin levels, Risk factors

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References


Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2001;104(3):365-72.

Fuster V, Badimon L, Cohen M, Ambrose JA, Badimon JJ, Chesebro J. Insights into the pathogenesis of acute ischemic syndromes. Circulation. 1988;77(6):1213-20.

Corti R, Fuster V, Badimon JJ, Hutter R, Fayad ZA. New understanding of atherosclerosis (clinically and experimentally) with evolving MRI technology in vivo. Ann NY Acad Sci. 2001;947:181-8.

Kinlay S, Libby P, Ganz P. Endothelial function and coronary artery disease. Curr Opin Lipidol. 2001;12(4):383-9.

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

Jeney V, Balla J, Yachie A, Varga Z, Vercellotti GM, Eaton JW, et al. Pro-oxidant and cytotoxic effects of circulating heme. Blood. 2002;100(3):879-87.

Sarady AJK, Liu F, Gallo D, Nakao A, Overhaus M, Ollinger R, et al. Biliverdin administration protects against endotoxin-induced acute lung injury in rats. Am J Physiol Cell Mol Physiol. 2005;289(6):1131-7.

Vamadevan A, Prabhakaran D. Coronary heart disease in Indians: Implications of the Interheart study. Indian J Med Res. 2010;132(5):561-6.

Sandoval Y, Thygesen K, Jaffe AS. The Universal Definition of Myocardial Infarction: Present and Future. Circulation. 2020;141(18):1434-6.

Sidhu NS, Rangaiah SKK, Ramesh D, Veerappa K, Manjunath CN. Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India. Clin Med Insights Cardiol. 2020;14:97.

Chung SR, Yang TH, Shin HC, Jin HY, Seo JS, Jang JS, et al. Initial Total Bilirubin and Clinical Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention With Drug-Eluting Stents. Circ J. 2016;80(6):1437-44.

Sahin O, Akpek M, Elcik D, Karadavut S, Simsek V, Tulmac M, et al. Bilirubin levels and the burden of coronary atherosclerosis in patients with STEMI. Angiology. 2013;64(3):200-4.

Hamur H, Duman H, Bakirci EM, Kucuksu Z, Demirelli S, Kalkan K, et al. Bilirubin Levels and Thrombus Burden in Patients with ST-Segment Elevation Myocardial Infarction. Angiology. 2016;67(6):565-70.

Purushotham R, Gudage N, Ambali A. Study on relationship of total bilirubin with acute coronary syndrome (ACS) and associated risk factors. Int J Adv Med. 2018;5(1):100.

Okuhara K, Kisaka T, Ozono R, Kurisu S, Inoue I, Soga J, et al. Change in bilirubin level following acute myocardial infarction is an index for heme oxygenase activation. South Med J. 2010;103(9):876-81.

Xu C, Dong M, Deng Y, Zhang L, Deng F, Zhou J, et al. Relation of Direct, Indirect, and Total bilirubin to Adverse Long-term Outcomes Among Patients With Acute Coronary Syndrome. Am J Cardiol. 2019;123(8):1244-8.

Hopkins PN, Wu LL, Hunt SC, James BC, Michael VG, Williams RR. Higher Serum Bilirubin Is Associated With Decreased Risk for Early Familial Coronary Artery Disease. Arterioscler Thromb Vasc Biol. 1996;16(2):250-5.

Shen H, Zeng C, Wu X, Liu S, Chen X. Prognostic value of total bilirubin in patients with acute myocardial infarction: A meta-analysis. Medicine. 2019;98(3):13920.

Celik T, Kaya MG, Akpek M, Yarlioglues M, Sarli B, Topsakal R, et al. Does serum bilirubin level on admission predict TIMI flow grade and in-hospital MACE in patients with STEMI undergoing primary PCI. Angiology. 2014;65(3):198-204.

Gul M, Uyarel H, Ergelen M, Akgul O, Karaca G, Turen S, et al. Prognostic value of total bilirubin in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention. Am J Cardiol. 2013;111(2):166-71.

Huang FY, Peng Y, Huang BT, Yang Y, Pu X, Chen SJ, et al. The correlation between serum total bilirubin and outcomes in patients with different subtypes of coronary artery disease. Clin Chim Acta. 2017;465:101-5.

Yao HM, Shen DL, Zhao XY, Wang XF, Sun TW, Zhang JY, et al. Prognostic value of total bilirubin in patients with angina pectoris undergoing percutaneous coronary intervention. Int J Clin Exp Med. 2015;8(9):15930-9.

Acet H, Ertş F, Akıl MA, Polat N, Aydın M, Akyuz A, et al. A novel predictor of infarct-related artery patency before percutaneous intervention and in-hospital outcomes for ST-segment elevation myocardial infarction patients: serum bilirubin level. Postepy Kardiol Interwencyjnej. 2014;10(2):91-7.

Zhang MM, Gao Y, Zheng YY, Chen Y, Liu F, Ma YT, et al. Association of Fasting Serum Bilirubin Levels with Clinical Outcomes After Percutaneous Coronary Intervention: A Prospective Study. Cardiovasc Toxicol. 2017;17(4):471-7.