5 :: KDA, Korean Diabetes Association ::
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Subject    :    [2015 Oct;39(5)] Serum Total Bilirubin Levels Provide Additive Risk Information over the Framingham Risk Score for Identifying Asymptomatic Diabetic Patients at Higher Risk for Coronary Artery Stenosis
Writer KDA
Date 2015-12-08 10:17:01 Hit 6,360
Diabetes Metab J. 2015 Oct;39(5):414-423. English. Published online Oct 22, 2015.  http://dx.doi.org/10.4093/dmj.2015.39.5.414 
Copyright © 2015 Korean Diabetes Association
   
Serum Total Bilirubin Levels Provide Additive Risk Information over the Framingham Risk Score for Identifying Asymptomatic Diabetic Patients at Higher Risk for Coronary Artery Stenosis
Jaechan Leem,1 Eun Hee Koh,1 Jung Eun Jang,1 Chang-Yun Woo,1 Jin Sun Oh,1 Min Jung Lee,1 Joon-Won Kang,2 Tae-Hwan Lim,2 Chang Hee Jung,1 Woo Je Lee,1 Joong-Yeol Park,1 and Ki-Up Lee1
1Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
2Department of Radiology, University of Ulsan College of Medicine, Seoul, Korea.
Corresponding author: Ki-Up Lee. Department of Internal Medicine, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05506, Korea. Email: kulee@amc.seoul.kr 
 
Received August 27, 2014; Accepted November 24, 2014.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Background

The diagnosis of coronary artery disease (CAD) is often delayed in patients with type 2 diabetes. Serum total bilirubin levels are inversely associated with CAD. However, no studies have examined whether this can be used as a biochemical marker for identifying asymptomatic diabetic patients at higher risk for having obstructive CAD.

Methods

We performed a cross-sectional study of 460 consecutive asymptomatic patients with type 2 diabetes. All patients underwent coronary computed tomographic angiography, and their serum total bilirubin levels were measured. Obstructive CAD was defined as ≥50% diameter stenosis in at least one coronary artery.

Results

Serum total bilirubin tertiles showed an inverse association with the prevalence of obstructive CAD. In multivariate logistic regression analysis, the odds ratio for the highest versus the lowest tertile of total bilirubin was 0.227 (95% confidence interval [CI], 0.130 to 0.398), and an increment of 1 µmol/L in serum total bilirubin level was associated with a 14.6% decrease in obstructive CAD after adjustment for confounding variables. Receiver operating characteristic curve analysis showed that the area under the curve for the Framingham Risk Score (FRS) plus serum total bilirubin level was 0.712 (95% CI, 0.668 to 0.753), which is significantly greater than that of the FRS alone (P=0.0028).

Conclusion

Serum total bilirubin level is inversely associated with obstructive CAD and provides additive risk information over the FRS. Serum total bilirubin may be helpful for identifying asymptomatic patients with type 2 diabetes who are at higher risk for obstructive CAD.

   

Keywords: Bilirubin, Coronary artery disease, Diabetes mellitus, Multidetector computed tomography.

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