Physiologically increased total bilirubin is associated with reduced risk of first myocardial infarction: A meta-analysis and dose-response analysis

Yao, Miao-En; Su, Meiyi; Yi, Huang; Chen, Wei

doi:10.1016/j.numecd.2021.01.002

Cited by 10 publications

(8 citation statements)

References 57 publications

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“…The strategies for the other databases were similar but adapted where necessary. We also searched references to reviews with related or similar themes for additional research (21,22,(25)(26)(27).…”

Section: Search Strategymentioning

confidence: 99%

The Nonlinear Relationship Between Total Bilirubin and Coronary Heart Disease: A Dose-Response Meta-Analysis

Wang

Song

et al. 2022

Front. Cardiovasc. Med.

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Background: Evidence suggests that the total bilirubin has a protective effect on coronary heart disease (CHD), but the dose-response relationship remains controversial, and there is no meta-analysis to assess the relationship.Methods: As of October 1, 2021, relevant literature was selected from four databases (PubMed, Web of Science, Cochrane Library, and Embase) by using a retrieval strategy. The dose-response curve between the total bilirubin and CHD was fitted by a restricted cubic spline. Stata 12.0 was used for statistical analysis.Results: A total of 170,209 (6,342 cases) participants from 7 prospective studies were analyzed in our meta-analysis. We calculated the pooled relative risks (RRs) and 95% CIs for the association between serum bilirubin level and risk of CHD using random-effects models. Compared with the first quantile, the bilirubin level in the third quantile had a protective effect on the risk of CHD (RR, 0.90; 95% CI, 0.82–0.99). The restricted cubic spline functions depicted a U-type curve relationship between bilirubin (3.42–49 μmol/L) and CHD (Plinear < 0.001). When the bilirubin level was in the range of 3.42–13μmol/L, the protective effect of bilirubin on CHD was enhanced with increasing bilirubin levels. When the bilirubin level exceeded 13μmol/L, the protective effect of bilirubin weakened, and a dangerous effect gradually appeared with further increases in bilirubin levels.Conclusions: Compared with a low bilirubin level, a high bilirubin level has a protective effect on the risk of CHD, and there was a U-shaped dose-response relationship between them.

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Section: Search Strategymentioning

confidence: 99%

The Nonlinear Relationship Between Total Bilirubin and Coronary Heart Disease: A Dose-Response Meta-Analysis

Wang

Song

et al. 2022

Front. Cardiovasc. Med.

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“…Research conducted in the last few decades has revealed that bilirubin, a heme catabolism product with antioxidant, anti-inflammatory, and anti-apoptotic properties, may be implicated in the prognosis of CAD. 28 , 29 Li et al 29 performed a meta-analysis, finding that total bilirubin levels were positively correlated with myocardial infarction (MI) severity, and higher total bilirubin levels were associated with a greater odds of adverse outcomes in MI patients. Bilirubin acts as an antioxidant, scavenging peroxyl radicals as efficiently as alpha-tocopherol at concentrations in human plasma.…”

Section: Discussionmentioning

confidence: 99%

Age–Bilirubin–International Normalized Ratio (INR)–Creatinine (ABIC) Score, a Potential Prognostic Model for Long-Term Mortality of CAD Patients After PCI

Wang

Pan

Zheng

et al. 2023

JIR

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Background Given that age, international normalized ratio (INR), total bilirubin, and creatinine are reported to be independent risk factors for predicting outcome in patients with coronary artery disease (CAD), it is possible that the age–bilirubin–INR–creatinine (ABIC) score might be a potential prognostic model for patients with CAD. Methods A total of 6046 CAD patients after percutaneous coronary intervention (PCI) from the retrospective cohort study (Identifier: ChiCTR-ORC-16010153) were evaluated finally. The primary outcome long-term mortality and secondary endpoints mainly major adverse cardiovascular and cerebrovascular events (MACCEs) were recorded. Multivariate Cox regression models were used to determine risk factors for mortality and MACCEs. Results The ABIC score was significantly higher in the death group than in the survival group. After adjusting for other CAD risk factors, the ABIC score was identified to be an independent risk factor for long-term mortality by multivariate Cox analysis. When in the high ABIC group, the incidence of all-cause mortality would increased 1.7 times (adjusted HR=1.729 (1.347–2.218), P <0.001), and 1.5 times for cardiac death (adjusted HR=1.482 (1.126–1.951), P =0.005). Conclusion The present study indicated that ABIC score≥7.985 predicts high long-term mortality and cardiac death risk for PCI patients. The ABIC score might be a potential prognostic model for patients with PCI.

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“…Another meta-analysis has also reported a better prognosis for patients with arteriosclerotic diseases having higher serum total bilirubin levels [ 20 ]. Moreover, a meta-analysis found that higher bilirubin levels were associated with a reduced risk of first MI incidence [ 22 ]. On the other hand, meta-analyses have found a positive relationship between bilirubin levels and the incidence of MACE in patients with MI [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, a meta-analysis found that higher bilirubin levels were associated with a reduced risk of first MI incidence [ 22 ]. On the other hand, meta-analyses have found a positive relationship between bilirubin levels and the incidence of MACE in patients with MI [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…An inverse relationship was reported between serum bilirubin levels and atherosclerosis [ 19 ] and higher serum bilirubin levels were found to be associated with a better prognosis in patients with arteriosclerotic diseases [ 20 ]. Another meta-analysis found a U-shaped curve to depict the relationship between bilirubin and CVD [ 21 ] However, whereas elevated total bilirubin levels (within physiological limits) are reported to be associated with a lower risk of first MI [ 22 ], in patients with MI, a positive relationship is found between serum bilirubin levels and major adverse cardiovascular events (MACE) [ 23 ]. These observations provide an impetus for a review of studies that sought the associations between bilirubin levels and the prognosis of CAD.…”

Section: Introductionmentioning

confidence: 99%

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Role of bilirubin in the prognosis of coronary artery disease and its relationship with cardiovascular risk factors: a meta-analysis

Zhao

Pan

et al. 2022

BMC Cardiovasc Disord

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Background Bilirubin is a heme catabolism product with antioxidant, anti-inflammatory, and anti-apoptotic properties and is implicated in the prognosis of several diseases. This study evaluates the prognostic role of bilirubin in coronary artery disease (CAD) patients. Methods After identifying studies from the literature, meta-analyses were performed to achieve a) overall estimates of serum total bilirubin levels in patients with myocardial infarction (MI), non-MI CAD and healthy individuals; b) odds ratios (OR) of adverse outcomes between higher and lower total bilirubin levels; c) standardized mean difference (SMD) in total bilirubin levels in patients with high vs low CAD severity; and d) correlation between disease severity and total bilirubin. Metaregression analyses were performed to examine the relationship between cardiovascular risk factors and increasing quantiles of total bilirubin levels. Results Forty-three studies were identified. Pooled serum total bilirubin levels were 0.72 mg/dl [95% confidence interval (CI): 0.60, 0.83] in MI patients; 0.65 mg/dl [95% CI: 0.60, 0.69] in non-MI CAD patients; and 0.66 mg/dl [95% CI: 0.56, 0.75] in healthy individuals. Higher total bilirubin levels were associated with greater odds of adverse outcomes in MI patients (OR: 1.08 [95% CI: 0.99, 1.18]) but lower odds in non-MI CAD patients (OR: 0.80 [95%CI: 0.73, 0.88]). Compared to non-severe cases, total bilirubin levels were higher in patients with severe MI (SMD 0.96 [95% CI: − 0.10, 2.01]; p = 0.074) but were lower in severe non-MI CAD patients (SMD − 0.30 [95%CI: − 0.56, − 0.03]; p = 0.02). Total bilirubin levels correlated positively with MI severity (r = 0.41 [95% CI: 0.24, 0.59]; p < 0.01) but correlated negatively with non-MI CAD severity (r = − 0.17 [95% CI: − 0.48, 0.14]; p = 0.28). Female sex was inversely associated with increasing quantiles of bilirubin (meta-regression coefficient: − 8.164 [− 14.531, − 1.769]; p = 0.016) in MI patients. Conclusion Prognostic role of bilirubin for CAD appears complicated, as different odds are observed for MI and non-MI CAD patients which weakens the case of causal involvement of bilirubin in CAD etiology or prognosis.

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Physiologically increased total bilirubin is associated with reduced risk of first myocardial infarction: A meta-analysis and dose-response analysis

Cited by 10 publications

References 57 publications

The Nonlinear Relationship Between Total Bilirubin and Coronary Heart Disease: A Dose-Response Meta-Analysis

The Nonlinear Relationship Between Total Bilirubin and Coronary Heart Disease: A Dose-Response Meta-Analysis

Age–Bilirubin–International Normalized Ratio (INR)–Creatinine (ABIC) Score, a Potential Prognostic Model for Long-Term Mortality of CAD Patients After PCI

Role of bilirubin in the prognosis of coronary artery disease and its relationship with cardiovascular risk factors: a meta-analysis

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