Song Young Shin, Koo Bo Kyung, Cho Nam H, Moon Min Kyong
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
Am J Cardiol. 2014 Dec 1;114(11):1695-700. doi: 10.1016/j.amjcard.2014.08.043. Epub 2014 Sep 16.
The objective of this study was to investigate the effects of low serum bilirubin levels on the risk for future coronary artery disease (CAD) in a prospective cohort. CAD events were examined according to baseline serum bilirubin levels in a prospective large-scale, community-based Korean cohort in 2 subsequent prospective biennial surveys. A total of 8,593 subjects were included, 0.9% of whom reported newly developed CAD events during the 4 years of follow-up. Cox regression analyses showed that the lowest serum total bilirubin level category (bilirubin ≤0.32 mg/dl) was an independent risk factor for future CAD events (adjusted hazard ratio [HR] 1.890, 95% confidence interval [CI] 1.088 to 3.284; p = 0.024). Subjects with metabolic syndrome had a higher risk for future CAD events than those without metabolic syndrome (HR 3.366, 95% CI 2.079 to 5.448, p <0.001). Low bilirubin levels increased the CAD risk in subjects with metabolic syndrome further (HR 2.016, 95% CI 1.069 to 3.800; p = 0.030), with these subjects showing a >6 times higher risk for CAD than subjects with bilirubin levels >0.32 mg/dl and no metabolic syndrome (HR 6.228, 95% CI 3.118 to 12.437; p <0.001). In conclusion, the addition of low serum bilirubin levels to the traditional risk factors for CAD, such as metabolic syndrome, may yield an improvement of risk prediction.
本研究的目的是在一个前瞻性队列中调查低血清胆红素水平对未来冠心病（CAD）风险的影响。在随后的两次前瞻性两年期调查中，根据基线血清胆红素水平对一个前瞻性大规模、基于社区的韩国队列中的CAD事件进行了检查。共纳入8593名受试者，其中0.9%的人在4年随访期间报告有新发生的CAD事件。Cox回归分析显示，血清总胆红素水平最低类别（胆红素≤0.32mg/dl）是未来CAD事件的独立危险因素（调整后风险比[HR]1.890，95%置信区间[CI]1.088至3.284；p = 0.024）。患有代谢综合征的受试者未来发生CAD事件的风险高于没有代谢综合征的受试者（HR 3.366，95%CI 2.079至5.448，p<0.001）。低胆红素水平进一步增加了患有代谢综合征的受试者发生CAD的风险（HR 2.016，95%CI 1.069至3.800；p = 0.030），这些受试者发生CAD的风险比胆红素水平>0.32mg/dl且没有代谢综合征的受试者高6倍以上（HR 6.228，95%CI 3.118至12.437；p<0.001）。总之，将低血清胆红素水平纳入CAD的传统危险因素（如代谢综合征）中，可能会改善风险预测。
