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. 2015 Oct;39(5):414-23.
doi: 10.4093/dmj.2015.39.5.414. Epub 2015 Oct 22.

Serum Total Bilirubin Levels Provide Additive Risk Information over the Framingham Risk Score for Identifying Asymptomatic Diabetic Patients at Higher Risk for Coronary Artery Stenosis

Jaechan Leem  1 , Eun Hee Koh  1 , Jung Eun Jang  1 , Chang-Yun Woo  1 , Jin Sun Oh  1 , Min Jung Lee  1 , Joon-Won Kang  2 , Tae-Hwan Lim  2 , Chang Hee Jung  1 , Woo Je Lee  1 , Joong-Yeol Park  1 , Ki-Up Lee  1
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Serum Total Bilirubin Levels Provide Additive Risk Information over the Framingham Risk Score for Identifying Asymptomatic Diabetic Patients at Higher Risk for Coronary Artery Stenosis

Jaechan Leem et al. Diabetes Metab J. 2015 Oct.

Abstract

Background: The diagnosis of coronary artery disease (CAD) is often delayed in patients with type 2 diabetes. Serum total bilirubin levels are inversely associated with CAD. However, no studies have examined whether this can be used as a biochemical marker for identifying asymptomatic diabetic patients at higher risk for having obstructive CAD.

Methods: We performed a cross-sectional study of 460 consecutive asymptomatic patients with type 2 diabetes. All patients underwent coronary computed tomographic angiography, and their serum total bilirubin levels were measured. Obstructive CAD was defined as ≥50% diameter stenosis in at least one coronary artery.

Results: Serum total bilirubin tertiles showed an inverse association with the prevalence of obstructive CAD. In multivariate logistic regression analysis, the odds ratio for the highest versus the lowest tertile of total bilirubin was 0.227 (95% confidence interval [CI], 0.130 to 0.398), and an increment of 1 µmol/L in serum total bilirubin level was associated with a 14.6% decrease in obstructive CAD after adjustment for confounding variables. Receiver operating characteristic curve analysis showed that the area under the curve for the Framingham Risk Score (FRS) plus serum total bilirubin level was 0.712 (95% CI, 0.668 to 0.753), which is significantly greater than that of the FRS alone (P=0.0028).

Conclusion: Serum total bilirubin level is inversely associated with obstructive CAD and provides additive risk information over the FRS. Serum total bilirubin may be helpful for identifying asymptomatic patients with type 2 diabetes who are at higher risk for obstructive CAD.

Keywords: Bilirubin; Coronary artery disease; Diabetes mellitus; Multidetector computed tomography.

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Conflict of interest statement

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Receiver operating characteristic curves showing the ability of the Framingham risk score (FRS) alone or the FRS plus serum total bilirubin level to predict obstructive coronary artery disease. The area under the curve for the FRS plus serum total bilirubin level was 0.712 (95% confidence interval [CI], 0.668 to 0.753), significantly greater than that of the FRS alone (area under the curve, 0.654; 95% CI, 0.609 to 0.698). P=0.0028 for the comparison between the two areas.
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