Diabetes Metab J.  2015 Oct;39(5):414-423. 10.4093/dmj.2015.39.5.414.

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

• Leem J
• Koh EH
• Jang JE
• Woo CY
• Oh JS
• Lee MJ
• Kang JW
• Lim TH
• Jung CH
• Lee WJ
• Park JY
• Lee KU

• KMID: 2174015
• DOI: http://doi.org/10.4093/dmj.2015.39.5.414

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 > or =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 micromol/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.

Keyword

Bilirubin; Coronary artery disease; Diabetes mellitus; Multidetector computed tomography

MeSH Terms

Angiography
Bilirubin*
Biomarkers
Confounding Factors (Epidemiology)
Constriction, Pathologic
Coronary Artery Disease
Coronary Stenosis*
Coronary Vessels*
Cross-Sectional Studies
Diabetes Mellitus
Diagnosis
Humans
Logistic Models
Multidetector Computed Tomography
Odds Ratio
Prevalence
ROC Curve
Bilirubin

Figure

• 

  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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