Prevalence of ischemic heart disease (IHD) in asymptomatic patients with diabetes mellitus (DM) in developing countries

Objectives The diagnostic values of exercise ECG and MPI in asymptomatic pts with type-2 DM are still debated. Little is known about prevalence of silent IHD in DM pts in developing countries. Aim of this IAEA coordinated clinical trial is the evaluation of IHD prevalence in DM pts and in controls (C) by MPI and exercise(EX) ECG.

Methods 468 pts (300 DM and 168 C) enrolled at 14 sites in Asia, Africa, and Latin America were analyzed. The inclusion criteria were: DM duration >5 yrs, age>40 yrs, near-normal baseline ECG, no history of CAD. The C group had to have ≥1 major risk factor(s) but no DM. All pts had EX testing with gated-SPECT MPI. ECGs and MPI were interpreted blindly in 2 core labs. The images were scored for SSS, SRS and SDS using a 17-segment model.

Results There were 61% men in DM and 54% in C (P=ns). Mean ages were 60.2 and 56.8(P<.001). Hypertension, hyperlipidemia, active smoking and family history of CAD were present in DM and C in 72% vs.67% (P=ns),58% vs.67%(P=ns)81% vs.71% (P=.03) and 31% vs.47% (P=.001) respectively. No differences were observed in DM and C in the use of statins, beta-blockers, ACEI and aspirin. By ECG, IHD was present in 15% of DM and 12% of C(P=NS). The SSS, SDS and SRS >3 was more in DM than C, 24% vs.13% (P=.007), 20% vs.11% (P=.018) and 6% vs.2% (P=.094). Rest LV ejection fraction was 66.5% in DM and 70.4% in C (P=.001). There were no differences in ischemia in the 3 continents: 26% in Africa, 19% in Asia and 19% in Latin America (P=ns).

Conclusions This first international study shows more ischemia by MPI than by ECG and more ischemia in DM than in C pts