Related Experiment Videos
Microalbuminuria as a marker of silent myocardial ischaemia in IDDM patients
K A Earle1, M Mishra, A Morocutti
1Department of Diabetes and Endocrinology, UMDS, London, UK.
Abstract:
Insulin-dependent diabetic (IDDM) subjects with microalbuminuria have an increased long-term risk of overt cardiovascular disease; however, the early exposure to cardiovascular risk factors may increase their predisposition to current silent myocardial ischaemia. The frequency of silent myocardial ischaemia detected by stress echocardiography and electrocardiography was significantly greater in 32 asymptomatic IDDM patients with microalbuminuria compared to 32 normoalbuminuric IDDM patients (25% [n = 8] vs 6.3% [n = 2]; p = 0.03, odds ratio [95% CI] 6.3 [1.2, 37.8]). Elective coronary artery bypass grafting was required in 1 patient with microalbuminuria and silent myocardial disease. Microalbuminuria and poorer autonomic function were independently associated with silent myocardial ischaemia in multivariate analysis (p = 0.03 and p = 0.02, respectively). Screening for silent myocardial ischaemia using these non-invasive tests may be warranted in microalbuminuric IDDM which patients could be of considerable clinical importance.
Insights
Microalbuminuria in insulin-dependent diabetes (IDDM) significantly increases the risk of silent myocardial ischemia. Early screening for this condition is crucial in IDDM patients with microalbuminuria.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Microalbuminuria in insulin-dependent diabetes mellitus (IDDM) is linked to increased cardiovascular disease risk.
- Early cardiovascular risk factors may predispose IDDM patients to silent myocardial ischemia.
Purpose of the Study:
- To investigate the frequency of silent myocardial ischemia in asymptomatic IDDM patients with microalbuminuria.
- To identify predictors of silent myocardial ischemia in this population.
Main Methods:
- Stress echocardiography and electrocardiography were used to detect silent myocardial ischemia.
- A comparative analysis was performed between 32 microalbuminuric IDDM patients and 32 normoalbuminuric IDDM patients.
- Multivariate analysis was employed to identify independent associations.
Main Results:
- Silent myocardial ischemia was significantly more frequent in microalbuminuric IDDM patients (25%) compared to normoalbuminuric patients (6.3%).
- Microalbuminuria and impaired autonomic function were independently associated with silent myocardial ischemia.
- One patient with microalbuminuria and silent myocardial ischemia required coronary artery bypass grafting.
Conclusions:
- Asymptomatic IDDM patients with microalbuminuria have a higher prevalence of silent myocardial ischemia.
- Non-invasive screening for silent myocardial ischemia may be clinically important for microalbuminuric IDDM patients.
- Autonomic dysfunction is also a significant risk factor for silent myocardial ischemia in this cohort.