Circulating Total Bilirubin and Long-Term Prognosis in Patients With Previous Myocardial Infarction

Cao, Ye‐Xuan; Liu, Huihui; Li, Sha; Zhang, Meng; Guo, Yuan‐Lin; Wu, Na‐Qiong; Zhu, Cheng‐Gang; Dong, Qian; Qian, Jie; Li, Jianjun

doi:10.1016/j.jacasi.2022.11.002

Cited by 4 publications

(7 citation statements)

References 34 publications

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“…The literature contains substantial evidence of an association between physiologically higher TBil levels and reduced all-cause and cardiovascular mortality, respectively. The current report by Cao et al 5 demonstrates similar findings in secondary CVD prevention. Moreover, these authors also observed increasing risk above the upper reference level, by which a J-shaped risk curve was generated.…”

supporting

confidence: 82%

“…In this issue of JACC: Asia , Cao et al 5 have performed a prospective, observational study of long-term prognosis of circulating TBil within physiological levels and above, in 3,809 patients with a previous myocardial infarction and angiography-proven CVD. The reference range of TBil was defined as 5.1 to 17.1 μmol/L.…”

mentioning

confidence: 99%

“…The authors of the current paper 5 should be applauded for providing a broader insight into this interesting subject.…”

mentioning

confidence: 99%

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Prognostic Potential of Total Bilirubin in Secondary CVD Prevention

Nilsen

2023

JACC: Asia

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supporting

confidence: 82%

mentioning

confidence: 99%

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Prognostic Potential of Total Bilirubin in Secondary CVD Prevention

Nilsen

2023

JACC: Asia

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“…In a secondary prevention setting, Cao et al [ 12 ] demonstrated increased risk of CHD events in the two lower tertiles (bilirubin levels up to 14.3 µmol/L), as compared to the upper tertile of the reference range for total bilirubin. Although a total bilirubin level above 9 µmol/L may provide prognostic information, higher levels may not be practical for clinical management.…”

Section: Discussionmentioning

confidence: 99%

“…Physiological levels of total bilirubin are related to future CVD events and bilirubin may serve as a prognostic marker in both primary and secondary cardiovascular disease (CVD) prevention [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. The shape of the risk curve, whether linear, L-, U- or J-shaped, has been widely discussed [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Reports on the prognostic utility of bilirubin in elderly patients are scarce in primary prevention [ 13 ], and are seemingly lacking in secondary CVD prevention.…”

Section: Introductionmentioning

confidence: 99%

Total Bilirubin Yields Prognostic Information Following a Myocardial Infarction in the Elderly

et al. 2023

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Total bilirubin consists of an unconjugated form, solubilized by its binding to albumin, and a conjugated form representing a minor part of the circulating bilirubin. As total bilirubin in physiological concentrations is a powerful antioxidant, its concentration gradient may reflect the health status of an individual, and serve as a prognostic indicator of outcome in primary and secondary cardiovascular disease prevention. The aim of this study was to assess the association between total bilirubin and incident cardiovascular events following a myocardial infarction. Total bilirubin in serum was measured at baseline 2–8 weeks after hospitalization for an MI in 881 patients, aged 70 to 82 years, included in the OMEMI (Omega-3 Fatty acids in Elderly with Myocardial Infarction) study, where patients were followed-up for up to 2 years. The first major adverse clinical event (MACE) was the primary endpoint and consisted of nonfatal MI, unscheduled coronary revascularization, stroke, hospitalization for heart failure or all-cause death. As total bilirubin was non-normally distributed, log-transformed values and quartiles of bilirubin were analyzed using Cox regression models. The median (Q1, and Q3) baseline concentration of bilirubin was 11 (9, and 14) µmol/L, and higher log-transformed concentrations were associated with male sex, lower New York Heart Association (NYHA) class and non-smoking. MACE occurred in 177 (20.1%) patients during the follow-up. Higher concentrations of bilirubin were associated with a lower risk of MACE: HR 0.67 (95%CI 0.47–0.97) per log-unit increase, p = 0.032. Patients in the lowest quartile of bilirubin (<9 µmol/L) had the highest risk with HR 1.61 (95%CI 1.19–2.18), p = 0.002, compared to quartiles 2–4. This association remained significant even after adjusting for age, sex, body mass index (BMI), smoking status, NYHA class and treatment allocation: HR 1.52 (1.21–2.09), p = 0.009. Low concentrations of bilirubin (<9 µmol/L) are associated with increased nonfatal cardiovascular events or death in elderly patients with a recent myocardial infarction.

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