Association of serum total bilirubin level with severity of coronary atherosclerosis is linked to systemic inflammation
Related Experiment Video
Updated: Apr 16, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Mehmet Kadri Akboga1, Ugur Canpolat1, Asife Sahinarslan2
1Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Cardiology, Ankara, Turkey.
Insights
Higher serum total bilirubin levels are linked to reduced coronary artery disease (CAD) severity and inflammation markers like C-reactive protein (CRP). This suggests bilirubin may have anti-inflammatory effects in atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Inflammation Research
Background:
- Bilirubin's cardiovascular protective effects are known, primarily attributed to its antioxidant properties.
- Limited data exists on bilirubin's anti-inflammatory role in cardiovascular disease.
- Coronary artery disease (CAD) involves complex inflammatory processes.
Purpose of the Study:
- To investigate the association between serum total bilirubin levels and the severity of stable CAD.
- To evaluate bilirubin's relationship with inflammatory markers: C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and red cell distribution width (RDW).
Main Methods:
- Retrospective analysis of angiographic data from 1501 patients with stable CAD.
- Patients categorized into control, mild CAD, and severe CAD groups based on Gensini scores.
- Multivariable linear regression analysis used to determine associations between clinical/laboratory parameters and CAD severity.
Main Results:
- Serum total bilirubin levels were significantly higher in the control group compared to CAD groups.
- Total bilirubin showed a significant inverse association with CAD severity (β=-3.131, p<0.001).
- Inverse correlations observed between total bilirubin and CRP (r=-0.112), NLR (r=-0.070), and RDW (r=-0.074).
Conclusions:
- Serum total bilirubin levels are independently and inversely associated with coronary atherosclerosis severity in stable CAD patients.
- Higher total bilirubin levels correlate with lower levels of key inflammatory markers (CRP, NLR, RDW).
- These findings suggest a potential anti-inflammatory role for bilirubin in the coronary atherosclerotic process, beyond its antioxidant effects.
Objective:
Although cardiovascular protective action of bilirubin has been attributed to its antioxidant effect, there was scarce data regarding the anti-inflammatory properties. Herein, we aimed to assess the relationship between serum total bilirubin level and severity of coronary artery disease (CAD) in association with the direct inflammatory marker such as C-reactive protein (CRP), the other indirect markers included in inflammation process such as neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) in patients with stable CAD.
Methods:
Angiographic data of 1501 patients were analyzed in this retrospective cross-sectional study. Patients were categorized according to Gensini scores as control, mild CAD and severe CAD groups. The association of clinical and laboratory parameters with the severity of CAD were determined by multivariable linear regression analysis.
Results:
Total bilirubin level in the control group was significantly higher than those of the other groups. After multivariable linear regression analysis total bilirubin [β=-3.131 (-4.481, -1.782), p<0.001] was significantly associated with the severity of CAD. Futhermore, there was a moderate and significant inverse correlation between serum total bilirubin level and the severity of CAD (r=-0.173, p<0.001), CRP (r=-0.112, p<0.001), NLR (r=-0.070, p=0.026) and RDW (r=-0.074, p=0.027).
Conclusion:
Serum total bilirubin level was independently and inversely associated with the severity of coronary atherosclerosis in patients with stable CAD. In addition, total bilirubin level was inversely correlated with CRP, NLR and RDW. These results suggest that besides its already known effect on the oxidative stress, higher serum total bilirubin level may exhibit an anti-inflammatory effect in the coronary atherosclerotic process.
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