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Silent myocardial ischemia in diabetics with normal autonomic function
G Ahluwalia1, P Jain, S K Chugh
1Department of Cardiology, All India Institute of Medical Sciences, New Delhi.
International Journal of Cardiology
|February 1, 1995
Summary
Diabetic patients with coronary artery disease have a higher prevalence of silent myocardial ischemia, even without autonomic dysfunction. This condition is more common in those with severe coronary artery disease.
Area of Science:
- Cardiology
- Diabetology
- Ischemic Heart Disease
Background:
- Diabetes mellitus is a significant risk factor for cardiovascular disease.
- Silent myocardial ischemia (SMI) is a common complication in patients with coronary artery disease (CAD).
- Autonomic dysfunction is often associated with SMI in diabetic patients.
Purpose of the Study:
- To determine the prevalence of SMI in male diabetic patients with normal autonomic function.
- To correlate the presence and extent of SMI with the severity of CAD.
- To compare SMI prevalence between diabetic and non-diabetic patients.
Main Methods:
- Exercise electrocardiography (ECG) and ambulatory ECG monitoring were used to detect SMI.
- Coronary angiography was performed to assess the severity of CAD.
- A cohort of 20 matched non-diabetic patients served as controls.
Main Results:
- SMI was detected in 50% of diabetic patients via exercise ECG and 35% via ambulatory ECG, significantly higher than in non-diabetics (10% and 5%, respectively).
- In diabetic patients, SMI prevalence increased with CAD severity: 64% (3-vessel), 50% (2-vessel), and 20% (1-vessel).
- Ambulatory ECG showed SMI only in patients with 3-vessel disease in both groups.
Conclusions:
- Silent myocardial ischemia occurs more frequently in diabetic patients with CAD, irrespective of autonomic function.
- The prevalence of SMI is directly related to the severity of coronary artery disease.
- Diabetic patients with CAD represent a high-risk group for undetected myocardial ischemia.