Is Low Serum Bilirubin an Independent Risk Factor for Coronary Artery Disease in Men but Not in Women?

[摘要] For many years, the bile pigment bilirubin was considered to be only a toxic waste product formed during heme catabolism. Recent evidence, however, suggests that bilirubin acts as a potent physiologic antioxidant that may provide important protection against arteriosclerosis, coronary artery disease (CAD), and inflammation (1)(2)(3). The antioxidant capacity of bilirubin and its potent ability to scavenge peroxyl radicals have led to the concept that mildly increased circulatory bilirubin may have a physiologic function to protect against disease processes that involve oxygen and peroxyl radicals (4). Indeed, inverse correlations between the presence of CAD and total bilirubin concentrations in the circulation were reported recently in several independent studies (5)(6). Additionally, plasma bilirubin correlates inversely with several established risk factors for CAD, including smoking, increased LDL-cholesterol, diabetes, and obesity, but is directly proportional to the protective factor HDL-cholesterol (5)(7). The effect of bilirubin on the risk of cardiovascular disease is apparent in men (8) but is less clear in women (6)(9)(10). In the present study, we therefore examined the influence of gender on total bilirubin concentrations.All patients referred to the Department of Cardiology, University of Vienna, between August 1999 and September 2001 for whom clinical data were available were included in our study. Patients were divided in a CAD and a non-CAD group. The CAD group consisted of 544 patients (157 females and 387 males) with clinically relevant CAD. Clinically relevant CAD was defined as an exercise-induced ischemic ST-segment depression >0.1 mV (12%) (11) and/or a history of myocardial infarction (53%) or coronary intervention [coronary artery bypass (8%) or percutaneous transluminal coronary angioplasty (27%)]. In the non-CAD group (359 patients; 186 females and 173 males), the presence of CAD …

[学科分类] 过敏症与临床免疫学