Relative ischemic burden in different patients populations in Mataria district: a pilot study

ABSTRACT

In diabetic patients, cardiovascular disease remains the leading cause of death, and myocardial infarctions tend to be more extensive and have a poorer outcome than in age, weight and sex matched individuals without diabetes. Diabetes mellitus, which is one of the major risk factors for ischemic heart disease [IHD], is increasing all over the world especially in developing countries, raising with it the incidence of IHD. Most of the ischemic burden on the myocardium is silent, especially in diabetics, due to the presence of autonomic neuropathy. The aim of this study is to evaluate the relative incidence of silent ischemic episodes and the total ischemic burden in diabetic and non diabetic patients, whether known to be ischemic or not, in Mataria district. This study includes four groups of male individuals, aged 45 to 60 years, attending the outpatient clinic of Mataria Teaching Hospital. Group I includes 20 diabetic patients known to be ischemic; group II includes 20 diabetic patients clinically free from IHD; group III includes 20 non diabetic patients known to be ischemic and group IV includes 20 non diabetic non ischemic individuals. A 24-hours ambulatory ECG recording was done for all individuals and analyzed for significant ST-segment deviation. The results of this study show that ischemic patients whether diabetic or not, are significantly more hypercholesterolemic than non ischemic individuals. The number of patients showing ischemic episodes are greater in the diabetic ischemic group than in the ischemic non diabetic group [60% versus 45%], and the total number of episodes, whether manifest or silent was also greater in the former than in the latter group [71 49]. The study confirms also the fact that the number of silent ST shifts is much more than the symptomatic ones [81.7% versus 18.3% in diabetic ischemic patients, and 65.3% versus 34.7% in ischemic non diabetic patients]. Moreover, diabetic patients who are not known to be ischemic show more silent episodes than the control group. These findings confirm that episodes of silent ischemia are present in a good percentage of patients with angina and a higher prevalence of these episodes is present in diabetic patients. This should urge us to give more care to the diabetic patients, whether already diagnosed as ischemic or not. The proper and early detection of diabetic patients with silent ischemia will result in a more rapid initiation of appropriate treatment and a much more favorable outcome: