Association of serum bilirubin with oxidant damage of human atherosclerotic plaques and the severity of atherosclerosis

Bilirubin has protective effects against atherosclerotic cardiovascular diseases hypothetically due to its antioxidant-antilipoperoxidative properties. Thus, we investigated whether serum bilirubin is associated with oxidant damage, namely lipid peroxidation, of human atherosclerotic plaques and the severity of atherosclerosis. In this regard, we correlated the levels of serum total bilirubin (STB), direct (conjugated) bilirubin (SDB) and indirect (unconjugated) bilirubin (SIB) with those of fluorescent damage products of lipid peroxidation (FDPL) and lipid hydroperoxides (LOOH) of 32 endarterectomy-derived carotid atherosclerotic plaques. Moreover, we compared the levels of serum bilirubin and plaque lipoperoxides between two groups of patients of the study population with different severity of atherosclerosis as judged by the carotid stenosis degree, i.e., <90% (group A, n = 23) and ≥90% (group B, n = 9). Remarkably, the levels of STB were strongly inversely correlated with those of plaque FDPL (rS = -0.70, P < 0.0001) and LOOH (rS = -0.66, P < 0.0001), as were those of SIB (FDPL: rS = -0.68, P < 0.0001; LOOH: rS = -0.63, P < 0.0001). SDB had a weaker association with plaque FDPL (rS = -0.41, P < 0.05) and LOOH (rS = -0.35, P < 0.05). Moreover, the levels of STB, SDB and SIB were lower and those of plaque lipoperoxides higher in group B than in group A, pointing to the association of serum bilirubin and plaque oxidant burden with the severity of atherosclerosis. In conclusion, lowered serum bilirubin is associated with oxidant damage of human atherosclerotic plaques and the severity of atherosclerosis.