This Article Full Text Full Text (PDF) All Versions of this Article: 40/11/3422    most recent STROKEAHA.109.560649v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Kimm, H. Articles by Jee, S. H. PubMed PubMed Citation Articles by Kimm, H. Articles by Jee, S. H. Related Collections Epidemiology

(Stroke. 2009;40:3422.)
© 2009 American Heart Association, Inc.

Original Contributions

Low Serum Bilirubin Level as an Independent Predictor of Stroke Incidence

A Prospective Study in Korean Men and Women

Heejin Kimm, MD, PhD; Ji Eun Yun, PhD; Jaeseong Jo, BS Sun Ha Jee, PhD

From the Institute for Health Promotion and Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.

Correspondence to Sun Ha Jee, Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea. E-mail jsunha{at}yuhs.ac

Background and Purpose— Bilirubin is not only a waste end-product but also an antioxidant. Bilirubin is known to be associated with decrease in cardiovascular risk in men, but its relationship to stroke was not clearly understood.

Methods— Serum bilirubin concentrations were measured in 78 724 health examinees (41 054 men, aged 30–89 years) from 1994 to 2001. The subjects with potential hepatobiliary diseases or Gilbert syndrome were excluded from analysis. Stroke incidence outcome was collected from hospital records of admission attributable to stroke from 1994 to 2007.

Results— Serum bilirubin measurements were divided into 4 levels: 0 to 10.2, 10.3 to 15.3, 15.4 to 22.1, and 22.2 to 34.2 µmol/L. The number of stroke cases was 1137 in men and 827 in women. In Cox proportional hazard models, participants with a higher level of bilirubin showed lower hazard ratios in men with ischemic stroke after adjustment for multiple confounding factors compared to the lowest level of bilirubin (hazard ratio [HR], 0.72; 95% CI, 0.58–0.90 in level 3; HR, 0.66; 95% CI, 0.49–0.89 in level 4; P for trend=0.016). The risk of all stroke types also decreased as bilirubin levels increased (HR, 0.81; 95% CI, 0.68–0.97 in level 3; HR, 0.74; 95% CI, 0.58–0.94 in level 4; P for trend=0.0071). However, these associations were not seen in hemorrhagic stroke or in women.

Conclusions— These findings suggest that serum bilirubin might have some protective function against stroke risk in men.

Key Words: bilirubin • hemorrhagic stroke • ischemic stroke • stroke incidence