Vítek L; Schwertner HA

Language: Spanish
References: 19
Page: 94-95
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Background: Bilirubin, with recently recognized antioxidant and anti-inflammatory activity, has emerged as a candidate for atheroprotection. We hypothesized that higher levels of bilirubin would reduce susceptibility to peripheral arterial disease (PAD). Methods and results: We analyzed 7,075 adults with data available on the ankle brachial index, serum total bilirubin level, and PAD risk factors in the National Health and Nutrition Examination Survey (1999 to 2004), a nationally representative cross-sectional examination of the United States population. A 0.1 mg/dL increase in bilirubin level was associated with a 6% reduction in the odds of PAD (OR 0.94 [95% CI 0.90 to 0.98]) after adjustment for age, gender, race/ethnicity, smoking status, diabetes, hypertension, hypercholesterolemia, chronic kidney disease, CRP, and homocysteine. This result was not dependent on bilirubin levels above the reference range, liver disease, or alcohol intake. The inverse association of bilirubin with PAD tended to be stronger among men (OR 0.90 [95% CI 0.85 to 0.96]) compared with women (OR 0.97 [95% CI 0.91 to 1.04]; P (interaction) = 0.05), and was stronger among active smokers (OR 0.81 [95% CI 0.73 to 0.90]) compared with nonsmokers (OR 0.97 [95% CI 0.93 to 1.02]; P (interaction) ‹ 0.01). Conclusions: Increased serum total bilirubin level is associated with reduced PAD prevalence. This result is consistent with the hypothesis that bilirubin is protective from PAD.

REFERENCES

1. Vitek L, Schwertner HA. The heme catabolic pathway and its protective effects on oxidative stress-mediated diseases. Adv Clin Chem 2007; 43: 1-57.

2. Perlstein TS, Pande RL, Beckman JA, Creager MA. Serum total bilirubin level and prevalent lower-extremity peripheral arterial disease: National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. Arterioscler Thromb Vasc Biol 2008; 28: 166-72.

3. Breimer LH, Spyropolous KA, Winder AF, Mikhailidis DP, Hamilton G. Is bilirubin protective against coronary artery disease? Clin Chem 1994; 40: 1987-8.

4. Nicholl P, Mikhailidis D, Hamilton G, Spyropolous LK, Winder AF. Bilirubin and peripheral vascular disease. Br J Surg 1995; 82: 1561-2.

5. Kangas E, Teittinen K, Vilkko P, Utriainen S. Bilirubin and peripheral vascular disease. Br J Surg 1999; 86: 713.

6. Krijgsman B, Mikhailides DP, Winder AF, Hamilton G. Bilirubin and peripheral vascular disease [letter]. Br J Surg 2000; 87: 251-2.

7. Cerne D, Ledinski G, Kager G, Greilberger J, Wang XS, Jurgens G. Comparison of laboratory parameters as risk factors for the presence and the extent of coronary or carotid atherosclerosis: the significance of apolipoprotein B to apolipoprotein all ratio. Clin Chem Lab Med 2000; 38: 529-38.

8. 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; 32: 580-3.

9. Krijgsman B, Papadakis JA, Ganotakis ES, Mikhailidis DP, Hamilton G. The effect of peripheral vascular disease on the serum levels of natural anti-oxidants: bilirubin and albumin. Int Angiol 2002; 21: 44-52.

10. Vítek L, Novotný L, Šperl M, Holaj R, Spáil J. The inverse association of elevated serum bilirubin levels with subclinical carotid atherosclerosis. Cerebrovasc Dis 2006; 21: 408-14.

11. Yilmaz FM, Akay H, Duranay M, Yilmaz G, Oztekin PS, Koar U, et al. Carotid atherosclerosis and cardiovascular risk factors in hemodialysis and peritoneal dialysis patients. Clin Biochem 2007; 40: 1361-6.

12. Breimer LH, Wannamethee G, Ebrahim S, Shaper AG. Serum bilirubin and risk of ischemic heart disease in middle-aged British men. Clin Chem 1995; 41: 1504-8.

13. Troughton JA, Woodside JV, Young IS, et al. Bilirubin and coronary heart disease risk in the Prospective Epidemiological Study of Myocardial Infarction (PRIME). Eur J Cardiovasc Prev Rehabil 2007; 14: 79-84.

14. Novotný L, Vítek L. Inverse relationship between serum bilirubin and atherosclerosis in men: A meta-analysis of published studies. Exp Biol Med 2003; 228: 568-71.

15. Vítek L, Jirsa Jr. M, Brodanová M, Kaláb M, Mareek Z, Danzig V, Novotný L, et al. Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels. Atherosclerosis 2002; 160: 449-56.

16. Ioannou GN, Boyko EJ, Lee SP. The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999-2002. Am J Gastroenterol 2006; 101: 76-82.

17. Schindhelm RK, Diamant M, Dekker JM, Tushuizen ME, Teerlink T, Heine RJ. Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease. Diabetes Metab Res Rev 2006; 22: 437-43.

18. Schindhelm RK, Dekker JM, Nijpels G, Bouter LM, Stehouwer CD, Heine RJ, Diamant M. Alanine aminotransferase predicts coronary heart disease events: A 10-year follow-up of the Hoorn Study. Atherosclerosis 2007; 191: 391-6.

19. Ioannou GN, Weiss NS, Boyko EJ, Mozaffarian D, Lee SP. Elevated serum alanine aminotransferase activity and calculated risk of coronary heart disease in the United States. Hepatology 2006; 43: 1145-51.