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J Atheroscler Thromb. 2019 Aug 1;26(8):688-696. doi: 10.5551/jat.RV17035. Epub 2019 Jul 2.

Bilirubin and Endothelial Function.

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Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University.
Division of Regeneration and Medicine, Hiroshima University Hospital.
Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University.


Bilirubin is a fundamental metabolic end product of heme degradation. Despite acting as a cytotoxic metabolite at high concentrations, bilirubin at physiological concentrations has antioxidant effects, such as scavenging reactive oxygen species, leading to a decrease in oxidative stress. Endothelial dysfunction is an early feature of and plays an important role in the development and progression of atherosclerosis, leading to cardiovascular complications. One mechanism of endothelial dysfunction is an increase in oxidative stress, by which the bioavailability of nitric oxide is decreased. Therefore, bilirubin is expected to improve endothelial function, to inhibit the progression of atherosclerosis, and to reduce cardiovascular complications by inactivating oxidative stress through its antioxidant effects. In this review, we will focus on the clinical associations of the antioxidant bilirubin with endothelial function and cardiovascular complications.


Antioxidant; Bilirubin; Endothelial function; Gilbert's syndrome; Oxidative stress

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