Risk Factors for Silent Myocardial Ischemia in Type II Diabetic Patients

Document Type : Original Article

Abstract

Background- Silent myocardial ischemia is more common in diabetic patients than others. Early
detection plays an important role in the prevention of acute myocardial infarction and sudden
cardiac death. Routine screening of all diabetics is costly. The aim of this study was to
estimate the prevalence of silent myocardial ischemia in type 2 diabetes and define these highrisk
patients by routine screening tests.
Methods- Between May 2004 and May 2006, this cross-sectional study was performed on 500 type
2 diabetic patients referred to Kerman internal medicine and cardiovascular clinics. Inclusion
criteria were age between 35 and 70 years, absence of symptoms and resting
electrocardiographic signs of ischemia, evidence of retinopathy or peripheral vascular disease,
or at least one major atherogenic risk factor (except diabetes). All the patients underwent
treadmill exercise test or thallium scintigraphy with exercise or dipyridamole injection. Data
were analyzed with chi-square, t-test, and Mann-Whitney U tests.
Results- Five hundred patients, comprised of 232 men and 268 women, were evaluated. Screening
tests were positive in 86 (17.2%) patients. There was a significant statistical relation between
the duration of diabetes, low density lipoprotein cholesterol, family history of coronary artery
disease (CAD), retinopathy, and peripheral vascular disease with silent myocardial ischemia
(P<0.05). The prevalence of silent ischemia was not significantly different between the males
and females (P>0.05). Among the patients with silent ischemia, body mass index was higher
in the females and cigarette smoking was more common in the males (P<0.05).
Conclusion- With regard to the high frequency of silent myocardial ischemia in type 2 diabetes
mellitus, routine silent ischemia screening by exercise stress test should be recommended in
type 2 diabetes if any of these conditions are present: duration of diabetes more than ten years,
family history of CAD, LDL cholesterol higher than 160 mg/dL, retinopathy, or peripheral
vascular disease (Iranian Heart Journal 2008; 9 (2):37-42).

Keywords

Afsaneh Forood MD*, Mohammad Masomi MD

References

1. Stamler J, Vaccaro O, Neston JD, Wentworth D.
Diabetes, other risk factors and 12-yr
cardiovascular mortality for men screened in
the multiple risk factor intervention trial.
Diabetes Care 1993; 16: 434-444.
2. Fuller JH. Mortality trends and causes of death in
diabetic patients. Diabet Metab 1993; 19: 96-
99.
3. Panzram G. Mortality and survival in type 2
diabetes mellitus. Diabetologia 1987; 30: 123-
131.
4. Cosson E, Guimfack M, Paries J, Valensi P. Are
silent coronary stenoses predictable in diabetic
patients and predictive of cardiovascular
events? Diabetes Metab 2003; 29: 470-6.
5. Kannel WB, Wilson PWF. Risk factors that
attenuate the female coronary disease
advantage. Arch intern Med 1995; 155: 57-61.
6. Janand-Delenne B, Savin B, Habib G, Bory M,
Vogue P. Silent myocardial ischemia in
patients with diabetes. Diabetes Care 1999;
22(9): 1396-1400.
7. Laukkanen JA, Korl S, Lakka TA. Exerciseinduced
silent myocardial ischemia and
coronary morbidity and mortality in middle –
aged men. J Am Coll Cardiol 2001; 38: 72-79.
8. Braunwald D, Zipes P, Bono W. In: Braunwald’s
Heart Disease, A Textbook of Cardiovascular
Medicine. 7th ed., 2005; Elseivier and
Saunders Company, pp. 939- 953.
9. Zharov E, Kazankov IN, Grigor EV. Silent
myocardial ischemia in patients with diabetes
mellitus without the clinical manifestation of
ischemic heart disease. Kardiologia. 1993; 33:
16-18.
10. Fredenrich A, Castello-Ros S, Hieronimus S,
Baudouy M. Screening for silent myocardial
ischemia in diabetic patients. Diabetes Care
2000; 23(4): 563-64.
11. Gazzaruso C, Garzaniti A, Falcone C.
Assessment of asymptomatic coronary artery
disease in apparently uncomplicated type 2
diabetic patients. Diabetes Care 2002; 25(8):
1418-1424.
12. Koistinen MJ. Prevalence of asymptomatic
myocardial ischemia in diabetics subjects.
BMJ 1990; 301(6743): 92-5.
13. Milan Study on Atherosclerosis and Diabetes
(MISAD) Group: prevalence of unrecognized
silent myocardial ischemia and its association
with atherosclerotic risk factors in noninsulin-
dependent diabetes mellitus. Am J
Cardiol 1997; 79: 134-139.
14. Bacci S, Villella M, Villella A, Grill M, Fanelli
R. Screening for silent myocardial ischemia in
type 2 diabetic patients with additional
atherogenic risk factors. Eur J Endocrinology
2002; 147: 649-654.
15. Wackers F, Young L, Barrett E, Wittlin S.
Detection of silent myocardial ischemia in
asymptomatic diabetic subjects. Diabetes Care
2004; 27(8): 1954-1961.
16. Sargin H, Ozisik M, Nurcin C, Seven O. The
prevalence of silent ischemia in Turkish
patients with type 2 diabetes mellitus. Tohoku
J Exp Med 2005; 205: 351-355.
17. Sultan A, Piot Ch, Rasamisa O, Renard E. Risk
factors for silent myocardial ischemia in highrisk
type 1 diabetic patients. Diabetes Care
2004; 27(7): 1745-1747.
18. William SB, Cusco JA, Roddy MA, Creager MA.
Impaired nitric oxide mediated vasodilatation
in patients with non-insulin dependent
diabetes mellitus J Am Coll Cardiol 1996; 27:
567-574.
Iranian Heart Journal
Volume 9, Issue 2
June 2008
Pages 37-42

Files

Share

How to cite

Statistics