Serum Bilirubin Concentration is Associated with Left Ventricular Remodeling in Patients with Type 2 Diabetes Mellitus: A Cohort Study

• Published in: Diabetes therapy Vol. 9; no. 1; pp. 331 - 338
• Main Authors: Inoue, Tomoaki, Sonoda, Noriyuki, Hiramatsu, Shinsuke, Kimura, Shinichiro, Ogawa, Yoshihiro, Inoguchi, Toyoshi
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-02-2018; Springer Nature B.V
• Subjects: Anatomy & physiology; Blood pressure; Cardiology; Cardiovascular disease; Cohort analysis; Diabetes; Ejection fraction; Electrocardiography; Endocrinology; Glucose monitoring; Health risk assessment; Insulin; Internal Medicine; Liver; Medicine; Medicine & Public Health; Original Research; Left ventricular geometry; Echocardiography; Bilirubin; Diabetes
• ISSN: 1869-6953; 1869-6961
• DOI: 10.1007/s13300-018-0368-6

Introduction
Previous studies have shown that serum bilirubin concentration is inversely associated with the risk of cardiovascular disease. The relationship between serum bilirubin concentration and left ventricular geometry, however, has not been investigated in patients with diabetes mellitus.
Methods
In this cohort study, 158 asymptomatic patients with type 2 diabetes mellitus without overt heart disease were enrolled. Left ventricular structure and function were assessed using echocardiography. Serum bilirubin concentration, glycemic control, lipid profile, and other clinical characteristics were evaluated, and their association with left ventricular geometry was determined. Patients with New York Heart Association Functional Classification greater than I, left ventricular ejection fraction less than 50%, history of coronary artery disease, severe valvulopathy, chronic atrial fibrillation, or creatinine clearance less than 30 ml/min, and those receiving insulin treatment, were excluded.
Results
Univariate analyses showed that relative wall thickness (RWT) was significantly correlated with diastolic blood pressure (
P
 = 0.003), HbA1c (
P
 = 0.024), total cholesterol (
P
 = 0.043), urinary albumin (
P
 = 0.023), and serum bilirubin concentration (
P
 = 0.009). There was no association between left ventricular mass index and serum bilirubin concentration. Multivariate linear regression analysis showed that log RWT was positively correlated with diastolic blood pressure (
P
 = 0.010) and that log RWT was inversely correlated with log bilirubin (
P
 = 0.003). In addition, the patients with bilirubin less than 0.8 mg/dl had a higher prevalence of concentric left ventricular remodeling compared with those with bilirubin 0.8 mg/dl or more.
Conclusion
Our study shows that the serum bilirubin concentration may be associated with the progression of concentric left ventricular remodeling in patients with type 2 diabetes mellitus.