The Association Between Serum Bilirubin Level And Subclinical Atherosclerosis In Patients With Type 1 And Type 2 Diabetes

Objective: Patients with diabetes mellitus are at an increased risk of cardiovascular disease(CVD).Previous studies have showed that there's a critical association between bilirubin and CVD.Mildly elevated serum bilirubin levels may have important antiatherosclerotic effects.However,whether there's a relationship between serum bilirubin and atherosclerosis in diabetic population,especially type 1 diabetes(T1DM),remains unclear.Therefore,the current study take carotid intima–media thickness(C-IMT)as a surrogate marker of subclinical atherosclerosis,aims at evaluating the relationship between serum bilirubin levels and subclinical atherosclerosis in T1 DM,as well as the type 2 diabetes mellitus(T2DM)population.Methods: A total of 180 T1 DM patients(age range 18–80 years)and 180 age-and gender-matched T2 DM patients(a 1:1 proportion)who were hospitalized in the Department of Endocrinology and Metabolism of Shanghai Jiao Tong University Affiliated Sixth People's Hospital between January 2009 and September 2017 were enrolled in the study.Carotid ultrasonography was used to measure the C-IMT and increased C-IMT was defined as ? 0.9 mm.Results: When compared with the normal C-IMT group,the levels of total bilirubin(TBIL),direct bilirubin(DBIL)and indirect bilirubin(IBIL)were significantly lower in increased C-IMT group in both T1 DM and T2 DM population(all P<0.05).Moreover,the prevalence of increased C-IMT decreased as serum bilirubin increased(All P for trend <0.05).After adjusting for age,gender,blood pressure,glucose and other relevant factors,Logistic regression analysis showed that DBIL was negatively and independently correlated with increased C-IMT in T1 DM patients,whereas a lower serum TBIL was the independent risk factor for increased C-IMT in T2 DM patients.Conclusion: Serum bilirubin levels were negatively correlated with C-IMT in diabetic subjects,lower DBIL and IBIL were independent risk factors of subclinical atherosclerosis in T1 DM and T2 DM patients,respectively,which suggesting that the measurement of serum bilirubin may provide predictive information for the risk of CVD for diabetic patients.