J Lipid Atheroscler.  2020 Jan;9(1):195-204. 10.12997/jla.2020.9.1.195.

Association Between Serum Bilirubin and the Progression of Carotid Atherosclerosis in Type 2 Diabetes

• Lee I
• Lee HH
• Cho Y
• Choi YJ
• Huh BW
• Lee BW
• Kang ES
• Park SW
• Cha BS
• Lee EJ
• Lee YH
• Huh KB

• KMID: 2470811
• DOI: http://doi.org/10.12997/jla.2020.9.1.195

Abstract

OBJECTIVE
This study investigated whether serum bilirubin levels can predict the progression of carotid atherosclerosis in individuals with type 2 diabetes mellitus (T2DM).
METHODS
This observational study included 1,381 subjects with T2DM in whom serial measurements of carotid intima-media thickness (CIMT) were made at 1- to 2-year intervals for 6-8 years. The progression of carotid atherosclerosis was defined as newly detected plaque lesions on repeat ultrasonography. After dividing total serum bilirubin levels into tertiles, the association between total serum bilirubin at baseline and plaque progression status was analyzed.
RESULTS
Among 1,381 T2DM patients, 599 (43.4%) were categorized as having plaque progression in their carotid arteries. Those with plaque progression were significantly older; showed a higher prevalence of hypertension, abdominal obesity, and chronic kidney disease; and had a longer duration of T2DM, higher levels of total cholesterol (TC), triglycerides, and insulin resistance, and lower total bilirubin concentrations than those with no plaque progression. When total serum bilirubin levels were divided into tertiles, the highest tertile group was younger than the lowest tertile group, with higher levels of TC and high-density lipoprotein cholesterol. Multiple logistic regression analysis demonstrated that higher serum bilirubin levels were associated with a significantly lower risk of CIMT progression (odds ratio, 0.584; 95% confidence interval, 0.392-0.870; p=0.008). Age (p<0.001), body mass index (p=0.023), and TC (p=0.019) were also associated with the progression of carotid atherosclerosis in T2DM patients.
CONCLUSION
Total serum bilirubin is independently associated with progression of atherosclerosis in the carotid arteries in T2DM patients.

Keyword

Diabetes mellitus, type 2; Bilirubin; Carotid intima-media thickness; Atherosclerosis

MeSH Terms

Atherosclerosis
Bilirubin*
Body Mass Index
Carotid Arteries
Carotid Artery Diseases*
Carotid Intima-Media Thickness
Cholesterol
Diabetes Mellitus, Type 2
Humans
Hypertension
Insulin Resistance
Lipoproteins
Logistic Models
Obesity, Abdominal
Observational Study
Prevalence
Renal Insufficiency, Chronic
Triglycerides
Ultrasonography
Bilirubin
Cholesterol
Lipoproteins
Triglycerides

Figure

• 

  Fig. 1 Impact of serum bilirubin levels on the progression of carotid atherosclerosis. The percentage of patients experiencing plaque progression in each tertile of total bilirubin is shown. In the first tertile of serum bilirubin levels, the percentage of patients experiencing plaque progression was 45.8% (i.e., 54.2% did not show plaque progression). In the second tertile of serum bilirubin levels, 46.8% of patients showed plaque progression, and in the third tertile, the corresponding percentage was 37.9%. Using the linear by linear association method, the percentage of patients with plaque progression was found to show a decreasing trend with increasing serum bilirubin tertile (p=0.14).

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