Smoking cessation is followed by increases in serum bilirubin, an endogenous antioxidant associated with lower risk of lung cancer and cardiovascular disease

Nicotine Tob Res. 2014 Aug;16(8):1145-9. doi: 10.1093/ntr/ntu067. Epub 2014 May 8.


Introduction: Lower concentrations of serum bilirubin, an endogenous antioxidant, have been associated with risk of many smoking-related diseases, including lung cancer and cardiovascular disease, and current smokers are reported to have lower bilirubin levels than nonsmokers and past smokers. This study evaluates the effects of smoking cessation on bilirubin levels.

Methods: In a secondary analysis of a 6-week placebo-controlled trial of naltrexone for smoking cessation, indirect and total bilirubin concentrations were evaluated at baseline and following smoking cessation. Individuals who were continuously abstinent for 6 weeks (n = 155) were compared to those who were not (n = 193). Participants reported smoking ≥ 20 cigarettes daily at baseline and received smoking cessation counseling, 21 mg nicotine patch daily, and either placebo or 1 of 3 doses of naltrexone (25, 50, or 100mg) for 6 weeks. Change in indirect and total bilirubin following the quit date was measured at Weeks 1, 4, and 6 compared to baseline.

Results: Individuals who were continuously abstinent from smoking, independent of naltrexone condition, showed a significantly greater mean increase in indirect (~unconjugated) bilirubin (0.06 mg/dl, SD = 0.165) compared to those who did not (mean = 0.02, SD = 0.148, p = .015). Similar results were obtained for total bilirubin (p = .037).

Conclusions: Smoking cessation is followed by increases in bilirubin concentration that have been associated with lower risk of lung cancer and cardiovascular disease.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Cutaneous
  • Adult
  • Antioxidants / metabolism
  • Bilirubin / blood*
  • Cardiovascular Diseases / epidemiology*
  • Counseling
  • Double-Blind Method
  • Female
  • Humans
  • Lung Neoplasms / epidemiology*
  • Male
  • Middle Aged
  • Naltrexone / therapeutic use
  • Nicotine / administration & dosage
  • Risk Factors
  • Smoking / drug therapy
  • Smoking Cessation*
  • Tobacco Use Cessation Devices
  • Treatment Outcome


  • Antioxidants
  • Naltrexone
  • Nicotine
  • Bilirubin