Prevalence of Unrecognized Silent Myocardial Ischemia and Its Association With Atherosclerotic Risk Factors in Noninsulin-Dependent Diabetes Mellitus
Section snippets
Cases and Protocol
The present study involved the Diabetology and Cardiology Centers of seven hospitals in the Milan area. The protocol consisted in performing a maximal exercise electrocardiogram (ECG) followed by exercise thallium scintigraphy in the presence of a positive or equivocal result.[13] Each Diabetology Center consecutively enrolled 160 noninsulin-dependent diabetic outpatients of both sexes, aged 40 to 65 years, asymptomatic and with no previously known CAD. Exclusion criteria were: insulin therapy,
Electrocardiogram at Rest
The findings were normal in 837 patients. There was a fascicular anterior block in 3 patients, a right focal block in 2, signs of left ventricular hypertrophy in 24, and ST-T abnormalities in 59.
Exercise Electrocardiogram
The test was normal in 813 subjects (87.9%) and abnormal in 112 (12.1%, 81 men and 31 women). The test was judged positive in 70 patients (7.6%, 55 men and 15 women) for ST-segment depression. The test was judged equivocal in 42 patients (4.5%, 26 men and 16 women) for ST-segment depression in 27 and
Discussion
The reported prevalence data of unrecognized silent CAD in diabetic subjects are quite different, ranging from 9% to 48%.4, 5, 6, 7, 8, 9, 10, 11, 12 This variability could be due to the different patients' selection criteria and diagnostic approaches. In most studies patients are grouped either with insulin-dependent and noninsulin-dependent diabetes,4, 5, 6, 7, 8, 9 or with noninsulin-dependent diabetes and impaired glucose tolerance.10, 11 Some studies included subjects with a specific
References (28)
- et al.
Detection of silent myocardial ischemia in diabetes mellitus
Am J Cardiol
(1991) - et al.
Predictive value of clinical and exercise variables for detection of coronary artery disease in men with diabetes mellitus
Am J Cardiol
(1987) - et al.
Thallium stress testing does not predict cardiovascular risk in diabetic patients with end-stage renal disease undergoing cadaveric renal transplantation
Am J Med
(1991) - et al.
Computer-enhanced thallium scintigrams in asymptomatic men with abnormal exercise tests
Am J Cardiol
(1981) - et al.
Epidemiology of silent myocardial ischemia in asymptomatic middle-aged men (the ECCIS project)
Am J Cardiol
(1993) - et al.
Correlation of resting electrocardiographic ST-T wave abnormalities with exercise thallium stress testing in patients with known or suspected coronary artery disease
Am J Cardiol
(1994) - et al.
Diabetes and atherosclerosis: an epidemiologic view
Diabetes Metab Rev
(1987) - et al.
Diabetes mellitus and macrovascular complications. An epidemiological perspective
Diabetes Care
(1992) Silent myocardial ischemia: classification, prevalence and prognosis
Am J Med
(1985)- et al.
Asymptomatic myocardial ischemia in diabetes and its relationship to diabetic neuropathy: an exercise electrocardiography study in middle-aged diabetic men
Diabetes Care
(1986)
The exercise test in diabetic patients as studied by radio-electrocardiography
Circulation
Prevalence of asymptomatic myocardial ischaemia in diabetic subjects
Br Med J
Exercise testing with myocardial scintigraphy in asymptomatic diabetic males
Circulation
Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population
Circulation
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2019, Revista Portuguesa de CardiologiaCitation Excerpt :Unlike other studies,1,21,23,26,42 our analysis showed no differences in the patient delay of diabetic patients. It is known that diabetic patients frequently have altered perception of pain in MI, explained by diabetic neuropathy,43 and symptoms associated with diabetes, such as sudoresis and dizziness in hypoglycemic episodes, may confuse or mask the symptoms of MI.44,45 Nevertheless, a study with a large patient population showed that symptom characteristics (typical vs. atypical) do not explain the longer patient delay in diabetic patients reported in previous studies.26
Screening for the Presence of Cardiovascular Disease
2018, Canadian Journal of Diabetes
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See Appendix for a list of investigators and their affiliations.