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Serum total bilirubin level and prevalent lower-extremity peripheral arterial disease: National Health and Nutrition Examination Survey (NHANES) 1999 to 2004.
Arterioscler Thromb Vasc Biol 2008; 28(1):166-72AT

Abstract

BACKGROUND

Bilirubin, with recently recognized antioxidant and antiinflammatory activity, has emerged as a candidate for atheroprotection. We hypothesized that higher levels of bilirubin would reduce susceptibility to peripheral arterial disease (PAD).

METHODS AND RESULTS

We analyzed 7075 adults with data available on the ankle brachial index, serum total bilirubin level, and PAD risk factors in the National Health and Nutrition Examination Survey (1999 to 2004), a nationally representative cross-sectional examination of the United States population. A 0.1 mg/dL increase in bilirubin level was associated with a 6% reduction in the odds of PAD (OR 0.94 [95% CI 0.90 to 0.98]) after adjustment for age, gender, race/ethnicity, smoking status, diabetes, hypertension, hypercholesterolemia, chronic kidney disease, CRP, and homocysteine. This result was not dependent on bilirubin levels above the reference range, liver disease, or alcohol intake. The inverse association of bilirubin with PAD tended to be stronger among men (OR 0.90 [95% CI 0.85 to 0.96]) compared with women (OR 0.97 [95% CI 0.91 to 1.04]; P(interaction)=0.05), and was stronger among active smokers (OR 0.81 [95% CI 0.73 to 0.90]) compared with nonsmokers (OR 0.97 [95% CI 0.93 to 1.02]; P(interaction)<0.01).

CONCLUSIONS

Increased serum total bilirubin level is associated with reduced PAD prevalence. This result is consistent with the hypothesis that bilirubin is protective from PAD.

Authors+Show Affiliations

Brigham and Women's Hospital, Cardiovascular Division, Harvard Medical School, Boston, MA 02115, USA. tperlstein@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17975120

Citation

Perlstein, Todd S., et al. "Serum Total Bilirubin Level and Prevalent Lower-extremity Peripheral Arterial Disease: National Health and Nutrition Examination Survey (NHANES) 1999 to 2004." Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 28, no. 1, 2008, pp. 166-72.
Perlstein TS, Pande RL, Beckman JA, et al. Serum total bilirubin level and prevalent lower-extremity peripheral arterial disease: National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. Arterioscler Thromb Vasc Biol. 2008;28(1):166-72.
Perlstein, T. S., Pande, R. L., Beckman, J. A., & Creager, M. A. (2008). Serum total bilirubin level and prevalent lower-extremity peripheral arterial disease: National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. Arteriosclerosis, Thrombosis, and Vascular Biology, 28(1), pp. 166-72.
Perlstein TS, et al. Serum Total Bilirubin Level and Prevalent Lower-extremity Peripheral Arterial Disease: National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. Arterioscler Thromb Vasc Biol. 2008;28(1):166-72. PubMed PMID: 17975120.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum total bilirubin level and prevalent lower-extremity peripheral arterial disease: National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. AU - Perlstein,Todd S, AU - Pande,Reena L, AU - Beckman,Joshua A, AU - Creager,Mark A, Y1 - 2007/11/01/ PY - 2007/11/3/pubmed PY - 2008/1/9/medline PY - 2007/11/3/entrez SP - 166 EP - 72 JF - Arteriosclerosis, thrombosis, and vascular biology JO - Arterioscler. Thromb. Vasc. Biol. VL - 28 IS - 1 N2 - BACKGROUND: Bilirubin, with recently recognized antioxidant and antiinflammatory activity, has emerged as a candidate for atheroprotection. We hypothesized that higher levels of bilirubin would reduce susceptibility to peripheral arterial disease (PAD). METHODS AND RESULTS: We analyzed 7075 adults with data available on the ankle brachial index, serum total bilirubin level, and PAD risk factors in the National Health and Nutrition Examination Survey (1999 to 2004), a nationally representative cross-sectional examination of the United States population. A 0.1 mg/dL increase in bilirubin level was associated with a 6% reduction in the odds of PAD (OR 0.94 [95% CI 0.90 to 0.98]) after adjustment for age, gender, race/ethnicity, smoking status, diabetes, hypertension, hypercholesterolemia, chronic kidney disease, CRP, and homocysteine. This result was not dependent on bilirubin levels above the reference range, liver disease, or alcohol intake. The inverse association of bilirubin with PAD tended to be stronger among men (OR 0.90 [95% CI 0.85 to 0.96]) compared with women (OR 0.97 [95% CI 0.91 to 1.04]; P(interaction)=0.05), and was stronger among active smokers (OR 0.81 [95% CI 0.73 to 0.90]) compared with nonsmokers (OR 0.97 [95% CI 0.93 to 1.02]; P(interaction)<0.01). CONCLUSIONS: Increased serum total bilirubin level is associated with reduced PAD prevalence. This result is consistent with the hypothesis that bilirubin is protective from PAD. SN - 1524-4636 UR - https://www.unboundmedicine.com/medline/citation/17975120/Serum_total_bilirubin_level_and_prevalent_lower_extremity_peripheral_arterial_disease:_National_Health_and_Nutrition_Examination_Survey__NHANES__1999_to_2004_ L2 - http://www.ahajournals.org/doi/full/10.1161/ATVBAHA.107.153262?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -