Serum Antioxidant Levels Associated with Subcortical Ischemic Vascular Disease

Abstract

vascular dementia (vad) is deemed as the second most prevalent type of dementia 1 . Subcortical ischemic vascular disease (Sivd) comprises leukoaraiosis (la) and lacunar infarction (li), which is caused by chronic hypo-perfusion or small vascular occlusion. Subcortical ischemic vascular disease is the most common cause of vad 2 and is associated with the risk of stroke 3 . With this background, the diagnosis and interference of Sivd has received extensive attention. increasing evidence ABSTRACT: Objective: We aimed to examine changes in serum bilirubin and uric acid (ua) levels in subcortical ischemic vascular disease (Sivd). in addition, we investigated if altered serum bilirubin and ua levels correlate with the subtypes of Sivd as well as the severity of leukoaraiosis (la). Methods: this cross-sectional study included 1098 consecutive patients with slight symptoms, such as dizziness, vertigo etc. according to magnetic resonance imaging (Mri) appearances, they were divided into either Sivd group or controls (Cn), and the Sivd group was further grouped in lacunar infarction (li) and la subtypes, as well as different grades. Serum bilirubin and ua levels were determined by the vanadate oxidase method and enzymatic method respectively, after at least an eight hour overnight fasting, in all subjects. Results: the bilirubin level was obviously lower while the ua level was significantly higher in the Sivd group when compared with the controls. Moreover, the la subgroup presented more significant changes in bilirubin and ua when compared to the li subgroup in both males and females. the correlation was positive between the ua levels and the la severity (r=0.134, p=0.006). Multivariate regression analysis revealed that the odds ratio (95% Ci) for Sivd in the lowest tertile of total bilirubin (tbil<9.58μmol/l) and highest tertile of ua (ua>339μmol/l) were 2.702(1.936-3.770) and 2.135(1.521-2.996) respectively after adjusting for confounding variables. Conclusion: Serum bilirubin levels were lower, whereas ua levels were higher in Sivd patients when compared with controls in both males and females, especially in la patients. Moreover, serum ua levels positively correlated to la severity. RÉSUMÉ: Niveaux sériques d'antioxydants associés à la maladie vasculaire ischémique sous-corticale. Objectif : le but de l'étude était d'examiner les changements de niveaux de la bilirubine sérique et de l'acide urique chez les patients atteints d'une maladie vasculaire ischémique souscorticale (MviS). de plus, nous avons cherché à déterminer si une perturbation des niveaux de bilirubine sérique et d'acide urique était corrélée aux sous-types de MviS ainsi qu'à la sévérité de la leucoaraïose. Méthode : Mille quatre-vingt-dix-huit patients consécutifs présentant des symptômes légers comme des étourdissements, du vertige et d'autres symptômes de cette nature ont été inclus dans cette étude transversale. les patients ont été répartis en 2 groupes, soit le groupe témoin et le groupe MviS selon les constatations faites à l'imagerie par résona...

The level of bilirubin and the risk of ischemic stroke: a systematic review and dose-response meta-analysis of real-world studies

“…Subgroup analysis of two prospective cohort studies (1 publication) [19] showed that the total OR for every 1 µmol/L increment of the TBIL level for IS was 0.988 (95% CI: 0.981-0.995) after adjusting for potential risk factors, showing a signi cant difference. In the two cross-sectional studies [15,16], the summary OR for every 1 µmol/L increment of the TBIL level for IS was 0.968 (95% CI: 0.901-1.040) after adjusting for potential risk factors, showing no signi cant difference. There was mild heterogeneity in the cohort studies (I 2 = 36.0%, P = 0.211) and severe heterogeneity in the cross-sectional studies (I 2 = 91.9%, P < 0.001).…”

“…Five observational studies (4 publications) [10,15,16,19] explored the association between TBIL and IS for the highest versus the lowest levels of serum TBIL and for the dose-response analysis, including two prospective cohort studies (1 publications) [19], 1 case-control study [10], and two cross-sectional studies [15,16] involving 2312 ischemic stroke cases among 81,632 participants (Table 1). As Kimm 2009 separately reported results for men and women, we deemed them as two studies as mentioned previously.…”

“…Five observational studies (4 publications) [10,15,16,19] were included in the analysis of highest versus lowest levels of circulating TBIL and the risk of IS. There was mild heterogeneity between studies (I 2 = 39.6%, P = 0.157), and the random-effect model was used for this analysis.…”

“…In nine observational studies (7 publications) [10, 13-16, 19, 20], the correlation between the level of bilirubin and the risk of AS from the highest to the lowest levels of serum TBIL and the dose-response analysis were investigated. There were 2 prospective cohort studies [14,19], 1 case-control study [10], and 4 cross-sectional studies [13,15,16,20], involving 110,032 participants including 3,710 stroke subjects.…”

“…However, this question has raised interest of a small number of researchers. A large crosssectional study compared three types of bilirubin levels (TBIL, DBIL, and IBIL) in different subtypes of subcortical ischemic vascular disease (SIVD, included lacunar infarction (LI) and leukoaraiosis (LA)) [15]. It was observed that the decrease in bilirubin levels remained signi cant in both LA and LI subtypes when compared with controls.…”