ASSOCIATION OF LOW SERUM CONCENTRATION OF BILIRUBIN WITH INCREASED RISK OF CORONARY-ARTERY DISEASE

We examined serum bilirubin and various liver-function enzymes as poss ible risk factors for angiographically documented coronary artery dise ase (CAD). The studies involved a ''training'' set of 619 men for whom complete data on all risk factors considered were available, and a '' test'' set of 258 men for whom some risk factor data were not availabl e. In both study groups, the liver enzymes were not related to CAD; ho wever, In[total bilirubin] was inversely and statistically significant ly related to the presence of CAD, both univariately and multivariatel y after adjustment for the established risk factors of age, total chol esterol, high-density lipoprotein cholesterol, smoking history, and sy stolic blood pressure. A 50% decrease in total bilirubin was associate d with a 47% increase in the odds of being in a more severe CAD catego ry. Our data suggest that serum bilirubin is an inverse and independen t risk factor for CAD, with an association equivalent in degree to tha t of systolic blood pressure.