Korean Circ J.  2008 Aug;38(8):425-431. 10.4070/kcj.2008.38.8.425.

Correlation Between the Serum Bilirubin Level and the Coronary Microvascular Integrity in Diabetic Patients

• Choi UJ
• Yoon MH
• Choi SY
• Lim HS
• Yang HM
• Woo SI
• Hwang JW
• Kang SJ
• Choi BJ
• Hwang GS
• Shin JH
• Park JS
• Park SJ
• Lee YH
• Lee YS
• Tahk SJ

• KMID: 2225763
• DOI: http://doi.org/10.4070/kcj.2008.38.8.425

Abstract

BACKGROUND AND OBJECTIVES: Bilirubin has a protective role in suppressing atherosclerosis and coronary artery disease by its potent physiological antioxidant properties. There has been no comparative study on the relation between the bilirubin level and the coronary microvascular function in diabetic patients. This study investigated whether the bilirubin level correlates with the coronary microvascular integrity in diabetes by assessing the coronary flow velocities after successful percutaneous coronary intervention (PCI).
SUBJECTS AND METHODS
Fifty patients (31 males and 19 females, mean age 60+/-11) with angina and who received elective PCI were studied. Using an intracoronary Doppler wire, the coronary flow velocity reserve (CFR), the hyperemic microvascular resistance index and the phasic coronary flow velocity patterns were measured after PCI.
RESULTS
The mean value of the fasting blood glucose was 211+/-88 mg/dL, the man value of glycated hemoglobin A1c (HbA1c) was 8.1+/-1.6% and the mean serum total bilirubin level was 0.59+/-0.21 mg/dL. CFR was significantly correlated with the serum bilirubin level (r=0.485, p<0.001), HbA1c (r=-0.432, p=0.003) and the fasting blood glucose (r=-0.361, p=0.011). On multivariate analysis, HbA1c, bilirubin and left ventricular hypertrophy showed independent relationships with coronary microvascular dysfunction (p=0.003, p=0.004, p=0.033, respectively).
CONCLUSION
These results suggest that glycemic control and elevated serum bilirubin may protect diabetic patients from coronary microvascular dysfunction.

Keyword

Bilirubin; Diabetes mellitus; Microvasculature

MeSH Terms

Atherosclerosis
Bilirubin
Blood Glucose
Coronary Artery Disease
Diabetes Mellitus
Fasting
Female
Hemoglobins
Humans
Hypertrophy, Left Ventricular
Male
Microvessels
Multivariate Analysis
Percutaneous Coronary Intervention
Bilirubin
Blood Glucose
Hemoglobins

Figure

• 

  Fig. 1 The relationship among the microvascular indices, HbA1c and bilirubin. Serum bilirubin is plotted against CFR (A), bAPV (B), bDDT (C) and HbA1c (D). The correlation coefficients are shown. CFR: coronary flow reserve, bAPV: baseline average peak velocity, bDDT: baseline diastolic deceleration time, HbA1c: glycated hemoglobin A1c.

• 

  Fig. 2 The receiver operating characteristic (ROC) curve analysis and the adequate cut-off values of bilirubin and HbA1c for a CFR <2. The best cut-off values (BCVs) for a CFR <2 are 0.5 mg/dL (A) and 8.2% (B). HbA1c: hemoglobin A1c, AUC: area under the curve.

• 

  Fig. 3 Comparison of the CFR according to the median value of bilirubin and HbA1c. The CFR was higher for a bilirubin level >0.5 mg/dL and a HbA1c=8.1%. CFR: coronary flow reserve, HbA1c: hemoglobin A1c.

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