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Category: Volume 07 Issue 10 October 2019
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Title: Study of Serum Bilirubin Level in Coronary Artery Disease

Authors: Dr Nageswaran. B, Prof Dr M. Senthilvelan, Prof Dr K. Baburaj, Dr A. Elaiyaraja

 DOI: https://dx.doi.org/10.18535/jmscr/v7i10.111

Abstract

  

Background: Bilirubin is a strong antioxidant under physiological conditions and suppresses the oxidation of lipids and low density lipoproteins and prevents free radical injury. Lesser serum bilirubin levels are associated with Protein Kinase C activation, inflammation, and oxidative stress, which are known mediators of endothelial and microvascular dysfunction. The aim of the study was to assess the serum bilirubin levels and coronary artery disease in comparison with controls without coronary artery disease and its relation with ACS sub types such as STEMI, NSTEMI and unstable angina.

Methods: A hospital based analytical study was conducted for a period of two years in our medical college hospital. Patients attending casualty with STEMI, NSTEMI and Unstable Angina confirmed by ECG, ECHO and cardiac markers were taken as cases. Controls were selected and matched with age, gender and other co-morbid conditions. Total of 110 subjects were included in the study with 55 cases and 55 controls. General and systemic examination was conducted on all study subjects including laboratory investigations like complete blood count, renal function test, lipid profile, CKMB, Troponin I, HBsAg, HCVIgM, SGOT, SGPT, total bilirubin, direct bilirubin, in direct bilirubin, albumin and globulin levels. A 12 lead ECG and a trans thoracic echocardiogram was performed for all patients.

Results: Risk factors like diabetes mellitus, hypertension, smoking history, family history, fasting lipid profile and liver function tests were compared between the cases and controls and it was found that the serum bilirubin levels which includes total bilirubin, direct bilirubin and indirect bilirubin were 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). Bilirubin levels in people with STEMI were lower than NSTEMI and bilirubin levels in people with NSTEMI were lower than people with Unstable angina but the difference was not statistically significant.

Conclusions: This study confirmed a significant inverse association between the reduced serum bilirubin levels and the occurrence of Coronary artery disease. Thus total bilirubin may serve as a protective biomarker of CAD.

Keywords: Coronary artery disease, Risk factor, Serum bilirubin, STEMI, NSTEMI, unstable angina.

References

  1. Hansson GK, Robertson AK, Söderberg - Nauclér C. Inflammation and atherosclerosis. Annu Rev Pathol. Mech Dis. 2006 Feb 28;1: 297-329.
  2. Louise D. Bilirubin protects against heart disease. Medical Xpress.
  3. Mayer M. Association of serum bilirubin concentration with risk of coronary artery disease. Clin Chem. 2000 Nov 1; 46(11):1723-7.
  4. 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
  5. 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.
  6. 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.
  7. Morita T. Heme oxygenase and atherosclerosis. Arterioscler Thromb Vasc Biol. 2005; 25(9):1786- 95.
  8. 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.
  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.
  10. Zheng-Yun Zhang, MD; Lu-Qin Bian, MD; Sung-Joo Kim, MD, PHD; CaiCun Zhou, MD, PHD; Yoon-Ho Choi, MD. Inverse Relation of Total Serum Bilirubin to Coronary Artery Calcification Score Detected by Multidetector Computed Tomography in Males. Clin. Cardiol. 35, 5, 301–306 (2012) 301 Published online in Wiley Online Library (wileyonlinelibrary.com) DOI:10. 1002/ clc. 21964 2012 Wiley Periodicals, Inc.
  11. 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.
  12. Freeman R. Hormone replacement therapy (estrogen and progesterone): is it necessary for heart disease prevention?. Preventive Cardiol. 2000 Jan;3(1):21- 4.
  13. Rong Fu,1Xu Song,2 Dexing Su,3 Shunrong Li,4 Lizhen Gao,5 and Chunmei Ji6  Serum STLT-1 and bilirubin levels in patients with acute coronary syndrome and correlation with prognosis. Experimental and Therapeutic Medicine 16: 241-245, 2018
  14. 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.

Corresponding Author

Prof Dr M. Senthilvelan

Professor & HOD, Department of General Medicine, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamilnadu, India