The objective of this study was to investigate the effects of low serum bilirubin
levels on the risk for future coronary artery disease (CAD) in a prospective cohort.
CAD events were examined according to baseline serum bilirubin levels in a prospective
large-scale, community-based Korean cohort in 2 subsequent prospective biennial surveys.
A total of 8,593 subjects were included, 0.9% of whom reported newly developed CAD
events during the 4 years of follow-up. Cox regression analyses showed that the lowest
serum total bilirubin level category (bilirubin ≤0.32 mg/dl) was an independent risk
factor for future CAD events (adjusted hazard ratio [HR] 1.890, 95% confidence interval
[CI] 1.088 to 3.284; p = 0.024). Subjects with metabolic syndrome had a higher risk
for future CAD events than those without metabolic syndrome (HR 3.366, 95% CI 2.079
to 5.448, p <0.001). Low bilirubin levels increased the CAD risk in subjects with
metabolic syndrome further (HR 2.016, 95% CI 1.069 to 3.800; p = 0.030), with these
subjects showing a >6 times higher risk for CAD than subjects with bilirubin levels
>0.32 mg/dl and no metabolic syndrome (HR 6.228, 95% CI 3.118 to 12.437; p <0.001).
In conclusion, the addition of low serum bilirubin levels to the traditional risk
factors for CAD, such as metabolic syndrome, may yield an improvement of risk prediction.
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Article info
Publication history
Published online: September 14, 2014
Accepted:
August 26,
2014
Received in revised form:
August 26,
2014
Received:
June 11,
2014
Footnotes
Drs. Song and Koo equally contributed to this work.
See page 1700 for disclosure information.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
