Total Bilirubin Yields Prognostic Information Following a Myocardial Infarction in the Elderly
Total bilirubin consists of an unconjugated form, solubilized by its binding to albumin, and a conjugated form representing a minor part of the circulating bilirubin. As total bilirubin in physiological concentrations is a powerful antioxidant, its concentration gradient may reflect the health statu...
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| Format: | Article |
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MDPI AG
2023-05-01
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| Series: | Antioxidants |
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| Online Access: | https://www.mdpi.com/2076-3921/12/6/1157 |
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| author | Dennis Winston T. Nilsen Peder Langeland Myhre Svein Solheim Sjur Hansen Tveit Are Annesønn Kalstad Kristian Laake Arnljot Tveit Ingebjørg Seljeflot |
| author_facet | Dennis Winston T. Nilsen Peder Langeland Myhre Svein Solheim Sjur Hansen Tveit Are Annesønn Kalstad Kristian Laake Arnljot Tveit Ingebjørg Seljeflot |
| author_sort | Dennis Winston T. Nilsen |
| collection | DOAJ |
| description | Total bilirubin consists of an unconjugated form, solubilized by its binding to albumin, and a conjugated form representing a minor part of the circulating bilirubin. As total bilirubin in physiological concentrations is a powerful antioxidant, its concentration gradient may reflect the health status of an individual, and serve as a prognostic indicator of outcome in primary and secondary cardiovascular disease prevention. The aim of this study was to assess the association between total bilirubin and incident cardiovascular events following a myocardial infarction. Total bilirubin in serum was measured at baseline 2–8 weeks after hospitalization for an MI in 881 patients, aged 70 to 82 years, included in the OMEMI (Omega-3 Fatty acids in Elderly with Myocardial Infarction) study, where patients were followed-up for up to 2 years. The first major adverse clinical event (MACE) was the primary endpoint and consisted of nonfatal MI, unscheduled coronary revascularization, stroke, hospitalization for heart failure or all-cause death. As total bilirubin was non-normally distributed, log-transformed values and quartiles of bilirubin were analyzed using Cox regression models. The median (Q1, and Q3) baseline concentration of bilirubin was 11 (9, and 14) µmol/L, and higher log-transformed concentrations were associated with male sex, lower New York Heart Association (NYHA) class and non-smoking. MACE occurred in 177 (20.1%) patients during the follow-up. Higher concentrations of bilirubin were associated with a lower risk of MACE: HR 0.67 (95%CI 0.47–0.97) per log-unit increase, <i>p</i> = 0.032. Patients in the lowest quartile of bilirubin (<9 µmol/L) had the highest risk with HR 1.61 (95%CI 1.19–2.18), <i>p</i> = 0.002, compared to quartiles 2–4. This association remained significant even after adjusting for age, sex, body mass index (BMI), smoking status, NYHA class and treatment allocation: HR 1.52 (1.21–2.09), <i>p</i> = 0.009. Low concentrations of bilirubin (<9 µmol/L) are associated with increased nonfatal cardiovascular events or death in elderly patients with a recent myocardial infarction. |
| first_indexed | 2024-03-11T02:50:30Z |
| format | Article |
| id | doaj.art-3be7b513dbe24b5983967704af40ff99 |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-03-11T02:50:30Z |
| publishDate | 2023-05-01 |
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| record_format | Article |
| series | Antioxidants |
| spelling | doaj.art-3be7b513dbe24b5983967704af40ff992023-11-18T09:02:14ZengMDPI AGAntioxidants2076-39212023-05-01126115710.3390/antiox12061157Total Bilirubin Yields Prognostic Information Following a Myocardial Infarction in the ElderlyDennis Winston T. Nilsen0Peder Langeland Myhre1Svein Solheim2Sjur Hansen Tveit3Are Annesønn Kalstad4Kristian Laake5Arnljot Tveit6Ingebjørg Seljeflot7Department of Cardiology, Stavanger University Hospital, 4068 Stavanger, NorwayInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0315 Oslo, NorwayInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0315 Oslo, NorwayInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0315 Oslo, NorwayInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0315 Oslo, NorwayInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0315 Oslo, NorwayInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0315 Oslo, NorwayInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0315 Oslo, NorwayTotal bilirubin consists of an unconjugated form, solubilized by its binding to albumin, and a conjugated form representing a minor part of the circulating bilirubin. As total bilirubin in physiological concentrations is a powerful antioxidant, its concentration gradient may reflect the health status of an individual, and serve as a prognostic indicator of outcome in primary and secondary cardiovascular disease prevention. The aim of this study was to assess the association between total bilirubin and incident cardiovascular events following a myocardial infarction. Total bilirubin in serum was measured at baseline 2–8 weeks after hospitalization for an MI in 881 patients, aged 70 to 82 years, included in the OMEMI (Omega-3 Fatty acids in Elderly with Myocardial Infarction) study, where patients were followed-up for up to 2 years. The first major adverse clinical event (MACE) was the primary endpoint and consisted of nonfatal MI, unscheduled coronary revascularization, stroke, hospitalization for heart failure or all-cause death. As total bilirubin was non-normally distributed, log-transformed values and quartiles of bilirubin were analyzed using Cox regression models. The median (Q1, and Q3) baseline concentration of bilirubin was 11 (9, and 14) µmol/L, and higher log-transformed concentrations were associated with male sex, lower New York Heart Association (NYHA) class and non-smoking. MACE occurred in 177 (20.1%) patients during the follow-up. Higher concentrations of bilirubin were associated with a lower risk of MACE: HR 0.67 (95%CI 0.47–0.97) per log-unit increase, <i>p</i> = 0.032. Patients in the lowest quartile of bilirubin (<9 µmol/L) had the highest risk with HR 1.61 (95%CI 1.19–2.18), <i>p</i> = 0.002, compared to quartiles 2–4. This association remained significant even after adjusting for age, sex, body mass index (BMI), smoking status, NYHA class and treatment allocation: HR 1.52 (1.21–2.09), <i>p</i> = 0.009. Low concentrations of bilirubin (<9 µmol/L) are associated with increased nonfatal cardiovascular events or death in elderly patients with a recent myocardial infarction.https://www.mdpi.com/2076-3921/12/6/1157bilirubinprognosisagedmyocardial infarctionsecondary prevention |
| spellingShingle | Dennis Winston T. Nilsen Peder Langeland Myhre Svein Solheim Sjur Hansen Tveit Are Annesønn Kalstad Kristian Laake Arnljot Tveit Ingebjørg Seljeflot Total Bilirubin Yields Prognostic Information Following a Myocardial Infarction in the Elderly Antioxidants bilirubin prognosis aged myocardial infarction secondary prevention |
| title | Total Bilirubin Yields Prognostic Information Following a Myocardial Infarction in the Elderly |
| title_full | Total Bilirubin Yields Prognostic Information Following a Myocardial Infarction in the Elderly |
| title_fullStr | Total Bilirubin Yields Prognostic Information Following a Myocardial Infarction in the Elderly |
| title_full_unstemmed | Total Bilirubin Yields Prognostic Information Following a Myocardial Infarction in the Elderly |
| title_short | Total Bilirubin Yields Prognostic Information Following a Myocardial Infarction in the Elderly |
| title_sort | total bilirubin yields prognostic information following a myocardial infarction in the elderly |
| topic | bilirubin prognosis aged myocardial infarction secondary prevention |
| url | https://www.mdpi.com/2076-3921/12/6/1157 |
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