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Does Bilirubin Level Have an Effect on Serum Lipid Parameters and Atherogenic Plaque Formation?

We read the article entitled ‘‘Serum Bilirubin Level and Aortic Intima-Media Thickness in Patients Without Clinical Manifestation of Atherosclerotic Cardiovascular Disease’’ by Kalkan et al with interest. The cardioprotective effect of bilirubin has been reported in some studies. Kalkan et al showed that lower serum bilirubin level might be an independent predictor of subclinical thoracic atherosclerosis, and serum bilirubin level was negatively associated with high-sensitivity C-reactive protein and aortic intima–media thickness. There are some reports regarding the relationship between total bilirubin levels and atherosclerosis. However, the measurement of conjugated, unconjugated, or total bilirubin levels were not reported by Kalkan et al. In addition, patients with known atherosclerotic heart disease were excluded. If such patients were included, a comparison could have been made. There are different studies about the effects of bilirubin on cardiovascular parameters. For example, Cüre et al concluded that increased bilirubin levels are associated with decrease in noninvasive electrocardiographic parameters in Gilbert syndrome. The contribution of serum bilirubin level to the atherosclerotic process has not been fully clarified.