Study of silent myocardial ischemia in type 2 diabetic males

ABSTRACT

Patients with diabetes have two to four folds greater risk of death from coronary artery disease than age-matched non diabetic individuals. Accelerated coronary and peripheral vascular atherosclerosis is one of the most common and chronic complications of diabetes mellitus. A recent aspect of coronary artery disease in this condition is its silent nature. Is to detect the prevalence of silent myocardial ischemia [SMI] in type 2 diabetic males in our locality and to select male diabetic population who should be screened for SMI. This study included 100 type 2 diabetic male patients with negative history of angina or anginal equivalent symptoms and thirty apparently healthy males as a control group. All subjects were studied as regard age, duration of DM, type of diabetic therapy, smoking, family history of IHD, blood pressure estimation, body mass index [BMI], fundus examination and presence of peripheral arterial disease. Laboratory estimation of fasting and post prandial blood glucose level, lipid profile, glycated hemoglobin [HbA[1c]], microalbuminurea, and C-reactive protein was done for all participants. Non invasive tests [NITs] including 12 leads resting ECG, trans-thoracic echocardiography, treadmill exercise ECG, myocardial perfusion imaging were done for all participants and patients positive for one or more N1Ts were subjected for coronary angiography. Twenty nine patients [29%] were positive for one or more NITs in the patients group compared to only one case [3.3%] in the control group. After the results of coronary angiography, 20 patients were positive for significant coronary artery stenosis in one or more vessels in the patients group while it was refused to be done by the patient in the control group. There was statistically significant difference as regard family history of DM and IHD, hypertension, and obesity with higher levels of microalbuminurea, C-reactive protein, total cholesterol, and triglycerides in the patients group than in the control. The patient group was subdivided into two subgroups according to the results of coronary angiography, 20 patients positive for SMI [positive for coronary angiography] and 80 patients negative for SMI [negative for coronary angiography]. Smoking, hypertension, obesity, hyperlipidemia, and family history of IHD were significantly higher in the diabetic subgroup positive for SMI compared to those negative for SMI. Most of the patients positive for SMI had have DM for more than 5 years duration. Type 2 diabetic male patients should be screened for detection of SMI when age above 50 years old, diabetes duration is more than 5 years [particularly if uncontrolled], presence of two or more cardiac risk factors and/or patients suffering from one or more of the chronic diabetic complications