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Relationship between bilirubin, apolipoprotein B, and coronary artery disease
1Department of Pathology, University of Louisville, KY 40292, USA.
Insights
Bilirubin shows an inverse relationship with coronary artery disease (CAD) risk, but lipoprotein markers offer better discrimination. Bilirubin
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Medical Diagnostics
Background:
- Coronary Artery Disease (CAD) is a leading cause of mortality worldwide.
- Lipoprotein lipids and apolipoprotein B (apo B) are established risk factors for CAD.
- The role of bilirubin as a potential risk factor or protective agent in CAD requires further investigation.
Purpose of the Study:
- To compare the diagnostic accuracy of bilirubin with lipoprotein lipids and apo B in assessing CAD risk.
- To investigate the relationship between bilirubin levels and the presence and severity of CAD.
- To explore potential interactions between bilirubin and lipoprotein markers in CAD prediction.
Main Methods:
- Retrospective analysis of 254 male patients, classified into normal (<20% stenosis) and CAD (>70% stenosis) groups.
- Diagnostic accuracy assessed using Receiver Operator Characteristic (ROC) curves.
- Multivariate analysis to correct for confounding variables and logistic regression to evaluate marker performance.
Main Results:
- Bilirubin demonstrated an inverse relationship with CAD risk, with ROC areas comparable to lipoproteins.
- Bilirubin showed limited discrimination power, particularly at lower false positive frequencies.
- Logistic regression revealed bilirubin as a weaker global marker than lipoproteins, with a significant correlation with apo B but not other lipid markers.
Conclusions:
- While bilirubin shows an inverse association with CAD, its practical discriminatory power is limited compared to lipoprotein markers.
- The interaction between bilirubin and apo B is a significant finding that warrants consideration in future CAD research.
- Further studies are needed to elucidate the complex role of bilirubin in the pathogenesis and progression of coronary artery disease.
Abstract:
Lipoprotein lipids and apo B from 254 male patients were compared with bilirubin as a risk factor for coronary artery disease (CAD). Patients were classified as: 1, Normal, all vessels < 20% stenosis, n = 83; or 2, CAD, at least one vessel > 70%, n = 171. Diagnostic accuracy was assessed by receiver operator characteristic curves (ROC). Corrections were made for possible confounding variables in the multivariate analysis. Upon ROC analysis, bilirubin showed an inverse relationship with risk of CAD, with areas under the ROC curve comparable to lipoprotein: however, bilirubin showed no discrimination below false positive frequencies of approximately 0.3. Logistic regression indicated that bilirubin was a weaker global marker than the lipoproteins and interacted with apo B. A highly significant correlation was found between bilirubin and apo B (p = 0.0025), but not with cholesterol, triglycerides, or high density lipoprotein cholesterol. Compared to lipoprotein markers, bilirubin provides little practical power of discrimination for CAD. Further studies of the affect of bilirubin on CAD must take its interaction with apo B into consideration.