Bilirubin and peripheral arterial disease: 15 years later

The past year has seen renewed interest in the link between peripheral arterial disease and plasma bilirubin. Two important studies that evaluate this relationship have been published: Perlstein et al., in a cross-sectional cohort study, and Kronenberg's group, in a retrospective case control study, provide substantial evidence that serum bilirubin may play a protective role in peripheral arterial disease as well as ischaemic heart disease, as suggested almost 15 years ago in a small retrospective analysis. Briefly, that study found that serum bilirubin concentrations in peripheral arterial disease patients were significantly (p < 0.001) lower than those in a healthy reference population. This editorial discusses the new data in a historical context.