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01-08-2014 | Original Paper

Association of bilirubin with coronary artery calcification and cardiovascular events in the general population without known liver disease: the Heinz Nixdorf Recall study

Authors: Amir A. Mahabadi, Nils Lehmann, Stefan Möhlenkamp, Hagen Kälsch, Marcus Bauer, Rainer Schulz, Susanne Moebus, Karl-Heinz Jöckel, Raimund Erbel, Gerd Heusch

Published in: Clinical Research in Cardiology | Issue 8/2014

Abstract

Background

Bilirubin is a product of heme oxygenase and an antioxidant per se. In selected cohorts and patient studies, bilirubin was associated with decreased risk for cardiovascular events. We aimed to determine the association of serum bilirubin with coronary artery calcification (CAC) and incident cardiovascular disease in the unselected general population.

Methods

Participants without prior coronary heart or liver disease were drawn from the population-based Heinz Nixdorf Recall study. CAC was measured from electron beam computed tomography and quantified using the Agatston method. Incident major cardiovascular events (coronary events, stroke, cardiovascular death) were assessed during follow-up. The association of bilirubin with CAC score and incident events was calculated using regression analysis.

Results

A total of 3,553 subjects (mean age 59.4 years, 44 % male) were included. Bilirubin was inversely correlated with CAC in men [estimated % change in (CAC + 1) per each gender-specific standard deviation of bilirubin [95 % confidence interval (CI): −6.1 (−11.6; −1.7) %, p = 0.032] but less so in women [−3.6 (−7.7; 0.2) %, p = 0.065], when adjusting for age only. With adjustment for traditional cardiovascular risk factors, the association was less pronounced [men: −2.5 (−7.5; 2.6) %, p = 0.35, women: −0.2 (−4.1; 3.5) %, p = 0.9]. Likewise, higher bilirubin by one standard deviation was associated with 19 % lower frequency of incident cardiovascular events in age- and gender-adjusted Cox regression analysis [hazard ratio (95 % CI): 0.81 (0.68; 0.96), p = 0.014]; this effect was slightly attenuated after adjustment for traditional cardiovascular risk factors [0.87 (0.73; 1.04), p = 0.13].

Conclusion

Our data from a general population suggest that a potential protective role of bilirubin in the atherosclerosis process is largely secondary to a more beneficial risk factor profile.

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Title: Association of bilirubin with coronary artery calcification and cardiovascular events in the general population without known liver disease: the Heinz Nixdorf Recall study
Authors: Amir A. Mahabadi
Nils Lehmann
Stefan Möhlenkamp
Hagen Kälsch
Marcus Bauer
Rainer Schulz
Susanne Moebus
Karl-Heinz Jöckel
Raimund Erbel
Gerd Heusch
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 8/2014
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-014-0697-z

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