Ong Kwok-Leung, Allison Matthew A, Cheung Bernard M Y, Wu Ben J, Barter Philip J, Rye Kerry-Anne
Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia; Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California, United States of America.
PLoS One. 2014 Apr 11;9(4):e94479. doi: 10.1371/journal.pone.0094479. eCollection 2014.
Due to its anti-oxidant and anti-inflammatory properties, bilirubin has been associated with reduced cardiovascular risk. A recent study demonstrated an L-shaped association of pre-treatment total bilirubin levels with total mortality in a statin-treated cohort. We therefore investigated the association of total bilirubin levels with total mortality in a nationally representative sample of older adults from the general population.
A total of 4,303 participants aged ≥ 60 years from the United States National Health and Nutrition Examination Survey 1999-2004 with mortality data followed up through December 31, 2006 were included in this analysis, with a mean follow-up period of 4.5 years.
Participants with total bilirubin levels of 0.1-0.4 mg/dl had the highest mortality rate (19.8%). Compared with participants with total bilirubin levels of 0.5-0.7 mg/dl and in a multivariable regression model, a lower total bilirubin level of 0.1-0.4 mg/dl was associated with higher risk of total mortality (hazard ratios, 1.36; 95% confidence interval, 1.07-1.72; P = 0.012), while higher levels (≥ 0.8 mg/dl) also tended to be associated with higher risk of total mortality, but this did not reach statistical significance (hazard ratios, 1.24; 95% confidence interval, 0.98-1.56; P = 0.072).
In this nationally representative sample of older adults, the association of total bilirubin levels with total mortality was the highest among those with a level between 0.1 and 0.4 mg/dl. Further studies are needed to investigate whether higher total bilirubin levels could be associated with a higher mortality risk, compared to a level of 0.5-0.7 mg/dl.
由于具有抗氧化和抗炎特性，胆红素与心血管风险降低相关。最近一项研究显示，在接受他汀类药物治疗的队列中，治疗前总胆红素水平与总死亡率呈L形关联。因此，我们在一个来自普通人群的具有全国代表性的老年人样本中，研究了总胆红素水平与总死亡率之间的关联。
本分析纳入了4303名年龄≥60岁、来自1999 - 2004年美国国家健康和营养检查调查且有截至2006年12月31日随访死亡率数据的参与者，平均随访期为4.5年。
总胆红素水平为0.1 - 0.4mg/dl的参与者死亡率最高（19.8%）。与总胆红素水平为0.5 - 0.7mg/dl的参与者相比，在多变量回归模型中，较低的总胆红素水平0.1 - 0.4mg/dl与总死亡率风险较高相关（风险比为1.36；95%置信区间为1.07 - 1.72；P = 0.012），而较高水平（≥0.8mg/dl）也倾向于与总死亡率风险较高相关，但未达到统计学显著性（风险比为1.24；95%置信区间为0.98 - 1.56；P = 0.072）。
在这个具有全国代表性的老年人样本中，总胆红素水平与总死亡率之间的关联在胆红素水平为0.1至0.4mg/dl的人群中最为明显。需要进一步研究以调查与0.5 - 0.7mg/dl的水平相比，较高的总胆红素水平是否可能与更高的死亡风险相关。
