Screening modalities for an asymptomatic cardiovascular disease in type 2 diabetics mellitus patients

Background: Asymptomatic myocardial ischemia is more common in diabetic than in the normal individual. Therefore, it becomes necessary to screen cardiovascular disease as early as possible.Objective: The present study was aimed to assess non-invasive procedures for the detection of asymptomatic myocardial ischemia and other coexistent risk factors in type 2 diabetics.Methods: A total of 76 patients with type 2 diabetes mellitus (T2DM) with no clinical history of coronary heart disease were included in the study and evaluated for silent myocardial ischemia by stress cardiac exercise tolerance test (ETT), echocardiography and electrocardiogram (ECG). Baseline clinical characteristic such as age, gender, Smoking, duration of diabetes, hemoglobin A1C (HbA1c) %, urinary microalbuminuria, hypertension, dyslipidemia and retinopathy were evaluated and reported. The clinical characteristic of ischemic ETT and normal ETT patients were compared.Results: The ETT showed an ischemic pattern in 22 patients (28.94%), the ECG was suggestive of ischemia in six patients (7.89%), echocardiography showed diastolic dysfunction in 18 (23.68%). Patients with microalbuminuria, hypertension, dyslipidemia and smoking and/or diastolic dysfunction were more prone than others to have ischemic ETT and patients with diastolic dysfunction had a higher prevalence of ischemic ETT. The prevalence of microalbuminuria, hypertension, dyslipidemia and smoking were found significantly higher in ischemic ETT when compared to normal ETT patients. The body mass index, HbA1c% and duration of diabetes were not shown significant deference in patients with positive ischemic ETT when compared to normal ischemic ETT patients.Conclusion: The cardiac ETT was found to be most helpful for detecting asymptomatic myocardial ischemia in T2DM patients on outpatient department basis. Study provides evidence for prevalence of asymptomatic myocardial infarction (MI) in diabetic patients. Moreover, this study will help to other diabetes care center for screening and prevention of asymptomatic MI in T2DM patients.