Silent myocardial ischemia was present in 18.31% of asymptomatic type 2 diabetes patients, with longer diabetes duration, sedentary lifestyle, hypertension, and microalbuminuria as key predictors.
Cross-Sectional (n=71)
No
Nearly one-fifth of asymptomatic patients with type 2 diabetes harbor silent myocardial ischemia, highlighting the potential value of routine non-invasive cardiovascular screening in this population, especially those with longer disease duration, hypertension, or microalbuminuria.
Background: Type 2 diabetes mellitus (T2DM) is associated with a substantially increased risk of cardiovascular complications, many of which remain silent until advanced stages. Silent myocardial ischemia (SMI), characterized by objective evidence of ischemia without anginal symptoms, is prevalent in diabetic populations due to autonomic neuropathy. Early identification of asymptomatic individuals harboring subclinical coronary artery disease (CAD) is crucial for timely intervention. Objectives: This study aimed to determine the prevalence of coronary risk factors and SMI in asymptomatic patients with T2DM and to identify clinical and biochemical predictors associated with positive stress test findings. Methods: This cross-sectional observational study enrolled 71 patients with T2DM (American Diabetes Association 2023 criteria) without known CAD at a tertiary care center in North India. All participants underwent treadmill stress testing (TMT) using the Bruce protocol. Demographic, lifestyle, clinical, and biochemical parameters were compared between TMT-positive (silent ischemia) and TMT-negative groups using chi-squared tests, Student's t-test, and Mann-Whitney U test as appropriate. Results: SMI was detected in 18.31% (13/71) of participants. TMT-positive individuals demonstrated significantly higher prevalence of sedentary lifestyle (84.6% vs. 50%; p=0.011), diabetes duration >5 years (84.6% vs. 44.8%; p=0.004), hypertension (46.2% vs. 25.9%; p<0.001), smoking (76.9% vs. 44.8%; p=0.018), and family history of hypertension (69.2% vs. 31%; p=0.005). Biochemically, the TMT-positive group showed elevated serum urea (p=0.003), creatinine (p<0.001), triglycerides (p<0.001), low-density lipoprotein (LDL) (p=0.034), total cholesterol (p=0.002), and urinary albumin-to-creatinine ratio (UACR) (p<0.001) and lower high-density lipoprotein (HDL) (p<0.001). Conclusion: A significant proportion of asymptomatic T2DM patients harbor SMI. Longer diabetes duration, sedentary lifestyle, hypertension, dyslipidemia, and microalbuminuria are key predictors. Routine cardiovascular screening using non-invasive modalities should be considered in high-risk diabetic individuals even without overt symptoms.
Goyal et al. (Sun,) conducted a cross-sectional in Type 2 Diabetes Mellitus (asymptomatic) (n=71). Treadmill stress testing (TMT) was evaluated on Prevalence of silent myocardial ischemia (SMI). Silent myocardial ischemia was present in 18.31% of asymptomatic type 2 diabetes patients, with longer diabetes duration, sedentary lifestyle, hypertension, and microalbuminuria as key predictors.