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[Silent ischemic cardiopathy: which diabetics to examine?]
G Charpentier1, J P Riveline, H Lardoux
1Service d'endocrino-diabétologie, centre hospitalier sud-francilien, Corbeil.
Insights
Diabetics have a higher risk of silent myocardial ischemia (SMI) due to increased heart disease. Identifying SMI in diabetics requires better risk stratification due to conflicting investigation guidelines.
Area of Science:
- Cardiology
- Diabetology
- Vascular Medicine
Context:
- Non-invasive coronary investigations show positive results in 11-52% of diabetic patients.
- Coronary angiography reveals hemodynamic lesions in 35-80% of diabetics with positive non-invasive tests.
- Diabetics exhibit a significantly higher prevalence of silent myocardial ischemia (SMI) compared to non-diabetic controls.
Purpose:
- To review the prevalence and risk factors of silent myocardial ischemia (SMI) in diabetic patients.
- To discuss the diagnostic challenges and current recommendations for investigating SMI in diabetes.
- To highlight the need for validated risk scores for SMI investigation in diabetics.
Summary:
- Silent myocardial ischemia (SMI) is more common in diabetics, likely due to higher rates of ischemic heart disease.
- Risk factors for SMI in diabetics overlap with general coronary artery disease risk factors, with some diabetes-specific considerations.
- Current French guidelines for SMI investigation in diabetics are considered contradictory, and a validated risk score is lacking.
Impact:
- Highlights the increased cardiovascular risk in diabetic populations.
- Underscores the need for improved diagnostic strategies for silent myocardial ischemia in diabetes management.
- Emphasizes the potential benefit of a validated risk score for guiding SMI investigations in diabetic patients.
Abstract:
Non-Invasive coronary investigations are positive in 12 to 52% (average 22%) of type II diabetics, and 11 to 30% (average 17%) of type i diabetics. These statistics vary according to bias of recruitment. Haemodynamic lesions are found at coronary angiography in 35 to 80% of patients who have at least one positive non-invasive investigation. Nine to 12% of diabetics have silent myocardial ischaemia (SMI) confirmed by coronary angiography, compared with 1.3 to 5.3% of non-diabetic controls paired for age and sex. The higher frequency of SMI in diabetics seems to be mostly due to the increased frequency of ischaemic heart disease in diabetics. The importance of cardiac autonomic neuropathy (CAN) in SMI is controversial. The risk factors associated with SMI are those usually associated with coronary artery disease: age, masculine gender, hypercholesterolaemia, hypertriglyceridaemia, hypertension, smoking, a family history of cardiovascular disease, insulin therapy (for type II diabetes), proteinuria, retinopathy, peripheral occlusive arterial disease.... The French recommendations for investigating SMI seem to be contradictory. A single risk score in a given patient could help codify the investigation of SMI in diabetics, but this type of score has not yet been validated.