ArticleClinical research in cardiology : official journal of the German Cardiac Society2014
Association of bilirubin with coronary artery calcification and cardiovascular events in the general population without known liver disease: the Heinz Nixdorf Recall study.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 5 of them syntheses that pooled it.
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Who cites it
25 citing papers in PubMed, 5 syntheses or guidelines pooled it, 42 citations in OpenAlex.
- Association between bilirubin levels and risk of stroke: a systematic review and meta-analysis.BMJ open · 2023Pooled it
- Role of bilirubin in the prognosis of coronary artery disease and its relationship with cardiovascular risk factors: a meta-analysis.BMC cardiovascular disorders · 2022Pooled it
- The Nonlinear Relationship Between Total Bilirubin and Coronary Heart Disease: A Dose-Response Meta-Analysis.Frontiers in cardiovascular medicine · 2021Pooled it
- Is serum total bilirubin a predictor of prognosis in arteriosclerotic cardiovascular disease? A meta-analysis.Medicine · 2019Pooled it
- Investigating the role of acute mental stress on endothelial dysfunction: a systematic review and meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2015Pooled it
- Association of serum total bilirubin with recurrent cardiovascular events in patients with in-stent restenosis: a stratified analysis by inflammatory status.BMC cardiovascular disorders · 2026Observational
- The Evaluation of the Genetic Variation Types of theGenetic testing and molecular biomarkers · 2024Article
- Bilirubin Elevation During Hospitalization Post Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation: Variation Trend, Related Factors, and Relevance to 1-Year Recurrence.Clinical interventions in aging · 2024Article
- Causal association between serum bilirubin and ischemic stroke: multivariable Mendelian randomization.Epidemiology and health · 2024Article
- Chronic disease outcome metadata from German observational studies - public availability and FAIR principles.Scientific data · 2023Article
- Association between bilirubin levels with incidence and prognosis of stroke: A meta-analysis.Frontiers in neuroscience · 2023Article
- Predictive values of bilirubin for in-hospital adverse events in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention.Clinics (Sao Paulo, Brazil) · 2023Article
- Are total bilirubin and high-sensitivity C-reactive protein independently associated with Type 2 diabetes mellitus in postmenopausal women?Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2021Article
- Baseline Serum Bilirubin and Risk of First Stroke in Hypertensive Patients.Journal of the American Heart Association · 2020Article
- Causal Associations Between Serum Bilirubin Levels and Decreased Stroke Risk: A Two-Sample Mendelian Randomization Study.Arteriosclerosis, thrombosis, and vascular biology · 2020Article
- Liver parameters as part of a non-invasive model for prediction of all-cause mortality after myocardial infarction.Archives of medical science : AMS · 2020Article
- Association of circulating total bilirubin level with ischemic stroke: a systemic review and meta-analysis of observational evidence.Annals of translational medicine · 2019Article
- Higher serum total bilirubin predicts high risk of 3-year adverse outcomes in patients undergoing primary percutaneous coronary intervention.Therapeutics and clinical risk management · 2019Article
- Role of Heme Oxygenases in Cardiovascular Syndromes and Co-morbidities.Current pharmaceutical design · 2018Review
- Elevated Serum Total Bilirubin Concentrations Are Negatively Associated with Diabetic Retinopathy among the Chinese Northeastern Population.International journal of endocrinology · 2018Article
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBilirubin is a product of heme oxygenase and an antioxidant per se. In selected cohorts and patient studies, bilirubin was associated with decreased risk for cardiovascular events. We aimed to determine the association of serum bilirubin with coronary artery calcification (CAC) and incident cardiovascular disease in the unselected general population.
methodsParticipants without prior coronary heart or liver disease were drawn from the population-based Heinz Nixdorf Recall study. CAC was measured from electron beam computed tomography and quantified using the Agatston method. Incident major cardiovascular events (coronary events, stroke, cardiovascular death) were assessed during follow-up. The association of bilirubin with CAC score and incident events was calculated using regression analysis.
resultsA total of 3,553 subjects (mean age 59.4 years, 44 % male) were included. Bilirubin was inversely correlated with CAC in men [estimated % change in (CAC + 1) per each gender-specific standard deviation of bilirubin [95 % confidence interval (CI): -6.1 (-11.6; -1.7) %, p = 0.032] but less so in women [-3.6 (-7.7; 0.2) %, p = 0.065], when adjusting for age only. With adjustment for traditional cardiovascular risk factors, the association was less pronounced [men: -2.5 (-7.5; 2.6) %, p = 0.35, women: -0.2 (-4.1; 3.5) %, p = 0.9]. Likewise, higher bilirubin by one standard deviation was associated with 19 % lower frequency of incident cardiovascular events in age- and gender-adjusted Cox regression analysis [hazard ratio (95 % CI): 0.81 (0.68; 0.96), p = 0.014]; this effect was slightly attenuated after adjustment for traditional cardiovascular risk factors [0.87 (0.73; 1.04), p = 0.13].
conclusionOur data from a general population suggest that a potential protective role of bilirubin in the atherosclerosis process is largely secondary to a more beneficial risk factor profile.
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