Serum bilirubin concentrations and incident coronary heart disease risk among patients with type 2 diabetes: the Dongfeng–Tongji cohort
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Elevated serum bilirubin levels are associated with decreased coronary heart disease (CHD) risk in cross-sectional studies among diabetic patients, but prospective evidence is limited. We investigated the relationship of serum bilirubin levels with incident CHD risk among type 2 diabetes patients.
In a prospective study of 2918 type 2 diabetes embedded in the Dongfeng–Tongji cohort, serum total bilirubin (TBil), direct bilirubin (DBil), and indirect bilirubin (IBil) were measured at baseline. Cox proportional hazards models were used to examine the association between serum bilirubin levels and CHD risk.
A total of 440 CHD cases were identified during 12,017 person-years of follow-up. Compared with extreme quartiles, the adjusted hazard ratio and 95% confidence interval of incident CHD were 0.74 (0.56–0.99) with P trend = 0.08 in IBil, while in TBil and DBil, the bilirubin–CHD associations were not significant. Moreover, serum TBil and IBil levels were interacted with drinking status on the risk of incident CHD (P interaction = 0.021 and 0.037, respectively), and the associations were evident in ever drinkers. In drinkers, when serum TBil or IBil concentrations increased 1 μmol/L, the CHD risk both decreased 6% (95% CIs 0.89–0.99 and 0.87–1.00, respectively).
Serum IBil levels were marginally related to decreased incident CHD risk among type 2 diabetes. Drinking could potentially enhance the associations of serum TBil and DBil levels with incident CHD risk.
KeywordsBilirubin Cohort Type 2 diabetes Coronary heart disease Chinese
The authors would like to thank all study participants for participating in the present DFTJ cohort study as well as all volunteers for assisting in collecting the samples and data.
This work was supported by the grant from the National Natural Science Foundation (Grant NSFC-81473051 and 81522040) and the Program for the New Century Excellent Talents in University (NCET-11-0169) for Meian He, the National Natural Science Foundation (Grant NSFC-81230069) for Tangchun Wu, the National Natural Science Foundation (Grant NSFC-71273083), and the Natural Science Foundation of Hubei Provincial Department of Education (D20162105) for Jing Wang.
JW, MAH, XMZ, TCW, and HDY conceived and designed the study. JW, YRL, XFW, XH, HH, FW, and CZY analyzed the data and wrote the first draft of the paper. XFW, XLL, KY collected, cleaned and analyzed the data; JY, PY, XPM, XMZ, HG, YJW, WHC, SW, and YL supervised the field activities and designed the analytic strategy. All authors participated in critical revision and approved the final version of the manuscript. No potential conflicts of interest relevant to this article were reported.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
The present study was approved by the Medical Ethics Committee of the School of Public Health, Tongji Medical College, and the Dongfeng General Hospital, the Dongfeng Motor Corporation. All participants provided written informed consents.
Human and animal rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.
Informed consent was obtained from all patients for being included in the study.
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