Serum Bilirubin Level is Negatively Correlated With Disease Progression of Peripheral Arterial Disease

Wang, Haiyang; Han, Peng; Zhang, Weihui; Liu, Bing; Li, Hali; Wang, Haijun; Huang, Renping

doi:10.1177/0003319711425175

Cited by 14 publications

(18 citation statements)

References 27 publications

(55 reference statements)

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“…The largest of these studies analysed 7,075 individuals from the National Health and Nutrition Examination Survey, and reported that increased bilirubin levels were associated with a reduced prevalence of PAD [19]. However, hard clinical endpoints were not explored in that and other similar smaller case-control studies [17][18][19][20]. Our study therefore for the first time extends these findings to amputation events.…”

Section: Discussionmentioning

confidence: 59%

“…Consistent with this notion, case-control studies have reported that individuals with elevated bilirubin levels caused by Gilbert's syndrome have a decreased incidence of atherosclerotic disease compared with normal controls [12,14]. Also, previous studies reported an inverse relationship between bilirubin levels and PAD prevalence [17][18][19][20]. However, the association between bilirubin and the hard clinical endpoint of amputation events has not been reported, to our knowledge.…”

Section: Introductionmentioning

confidence: 60%

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Plasma total bilirubin levels predict amputation events in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

et al. 2013

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Aims/hypothesis Bilirubin has antioxidant and antiinflammatory activities. Previous studies demonstrated that higher bilirubin levels were associated with reduced prevalence of peripheral arterial disease (PAD). However, the relationship between bilirubin and lower-limb amputation, a consequence of PAD, is currently unknown. We hypothesised that, in patients with type 2 diabetes, bilirubin concentrations may inversely associate with lower-limb amputation.Methods The relationship between baseline plasma total bilirubin levels and amputation events was analysed in 9,795 type 2 diabetic patients from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. The analysis plan was pre-specified. Lower-limb amputation was adjudicated blinded to treatment allocation. Relevant clinical and biochemical data were available for analyses. Amputation was a pre-specified tertiary endpoint. Results Bilirubin concentrations were significantly inversely associated with lower-limb amputation, with a greater than M. K. C. Ng and A. C. Keech are joint senior authors of this study Electronic supplementary material The online version of this article

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 60%

Plasma total bilirubin levels predict amputation events in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

et al. 2013

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“…Earlier researches have demonstrated an inverse correlation between serum bilirubin and the risk of coronary artery disease and decreased antioxidant activity of bilirubin in atherosclerotic lesions [1, 2]. Recent studies have confirmed the correlation between serum bilirubin levels and collateral development in patients with chronic total coronary occlusion [3], peripheral arterial disease [4], amputation events in type-2 diabetes mellitus [5], stroke severity and clinical outcomes [6]. Those results suggested that bilirubin may be a part of a cell defense strategy in those macro- and micro- angiopathies.…”

Section: Introductionmentioning

confidence: 99%

Association of serum total bilirubin levels with diastolic dysfunction in heart failure with preserved ejection fraction

Zheng

Xie

2014

biol res

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BackgroundLeft ventricular diastolic dysfunction is one of the main characteristics of heart failure patients with a preserved left ventricular ejection fraction. As bilirubin is regarded as an important endogenous antioxidant molecule, serum total bilirubin levels were compared between heart failure patients with a preserved left ventricular ejection fraction and normal controls in this study. We recruited 327 heart failure patients with a preserved left ventricular ejection fraction and 200 healthy controls. Patients were divided into 4 subgroups by their comprehensive echocardiographic manifestations, 1-mild, 2-moderate, 3-severe (reversible restrictive), 4-severe (fixed restrictive). Total bilirubin levels were compared using stepwise multiple regressions adjusted for selected factors.ResultsAfter adjusting for gender, age, smoking, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride, serum total bilirubin levels were significantly lower in the heart failure group compared with the control group (P < 0.01). Patients in the subgroup (4-severe) showed significantly (P < 0.05) lower levels of total bilirubin when compared with the subgroup (1-mild).ConclusionsTB level was negatively correlated with left ventricular diastolic dysfunction in heart failure patients with a preserved left ventricular ejection fraction, which might provide a new insight into the complicated mechanisms of heart failure with a preserved left ventricular ejection fraction.

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“…PAD is present in up to half of patients with DF and is an independent risk factor for the severity of DF as well as amputation [ 24 ]. Previous studies consistently found that elevated serum bilirubin levels were negatively associated with PAD [ 25 – 27 ], arterial stiffness [ 10 ], and carotid intima media thickness [ 28 ] in patients with DM. This inverse association is strongly supported by evidence arising from experimental studies.…”

Section: Discussionmentioning

confidence: 99%

Inverse Relationship Between Serum Bilirubin Levels and Diabetic Foot in Chinese Patients with Type 2 Diabetes Mellitus

et al. 2017

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BackgroundSeveral studies demonstrated that bilirubin, a potent endogenous antioxidant, is a strong protective factor for many diabetic complications such as nephropathy, retinopathy, neuropathy, and vasculopathy. The purpose of this study was to assess the association between serum bilirubin levels and diabetic foot (DF) in Chinese patients with type 2 diabetes mellitus (T2DM).Material/MethodsThe present cross-sectional study of bilirubin levels in relation to DF was conducted in 1,269 T2DM patients with (n=578) and without (n=691) DF. Blood test results were obtained on hospital admission, including total bilirubin (T-BIL), direct bilirubin (D-BIL), and indirect bilirubin (I-BIL). Data on Wagner classification and amputation procedure in patients with DF were collected by reviewing electronic medical records. Univariate or multivariate analysis were performed to explore the association between bilirubin and DF.ResultsSerum I-BIL levels were shown to play a protective role regarding the presence and severity of DF (OR=0.75, p=0.029 and OR=0.90, p=0.021, respectively). In addition, in a comparison of the lowest and highest tertiles of serum bilirubin concentration, the highest tertile of serum T-BIL (OR=0.51, p=0.011) and I-BIL (OR=0.28, p<0.001) was significantly related with a lower Wagner grade of DF. Patients with DF in the highest tertiles of T-BIL carried a significantly lower risk of amputation events than those in the lowest tertiles (OR=0.47, p=0.025).ConclusionsThe present study provided evidence that decreased serum bilirubin levels were independently associated with the presence and severity of DF and amputation events in patients with DF.

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Serum Bilirubin Level is Negatively Correlated With Disease Progression of Peripheral Arterial Disease

Cited by 14 publications

References 27 publications

Plasma total bilirubin levels predict amputation events in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

Plasma total bilirubin levels predict amputation events in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

Association of serum total bilirubin levels with diastolic dysfunction in heart failure with preserved ejection fraction

Inverse Relationship Between Serum Bilirubin Levels and Diabetic Foot in Chinese Patients with Type 2 Diabetes Mellitus

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