SILENT MYOCARDIAL ISCHEMIA AMONG ASYMPTOMATIC TYPE-2 DIABETIC PATIENTS
Main Article Content
Abstract
Objective: To determine the frequency of silent myocardial ischemia among asymptomatic type-2 diabetes mellitus patients.
Methodology: This was a Cross sectional descriptive study conducted, after approval from the institutional ethical and research committee. A total of 90 asymptomatic type-2 diabetic patients were recruited for the present study. After informed written consent participants were subjected to a symptom-limited exercise tolerance test to detect the presence of silent myocardial ischemia. Descriptive statistics were applied to find frequencies and percentages for qualitative variables, and mean and standard deviation was used for quantitative variables. SPSS version22 was used for data analysis.
Results: Among 90 type-2 asymptomatic diabetic patients, the frequency of silent myocardial ischemia was 36.7% (n=33). The frequency of silent myocardial ischemia among males and females was 57.6% and 42.4% respectively. Frequency of silent myocardial ischemia was found significantly more among patients with family history of CAD (60.6% vs 39.4%; p=0.029), prolonged duration of diabetes (15.2% vs 22.2% vs 63.6%; p=0.026) and group of patients with older age (9% vs 39.4 vs 51.6%; p=0.034). With respect to hypertension, smoking, obesity, and gender didn’t show statistically significant variation in the occurrence of silent myocardial ischemia.
Conclusion: More than one third patients of asymptomatic type-2 diabetes mellitus had silent myocardial ischemia. Those with a family history of CAD, prolonged duration of diabetes, and participants with older age were more at risk of underlying silent myocardial ischemia.
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References
Henning RJ. Type-2 diabetes mellitus and cardiovascular disease. Future Cardiol. 2018;14(6):491–509. DOI.org/10.2217/fca-2018-0045
Hernández C, Candell-Riera J, Ciudin A, Francisco G, Aguadé-Bruix S, Simó R. Prevalence and risk factors accounting for true silent myocardial ischemia: a pilot case-control study comparing type 2 diabetic with non-diabetic control subjects. Cardiovasc Diabetol. 2011 Dec;10(1): 1-&. DOI.org/10.1186/1475-2840-10-9
Khafaji HAH, Suwaidi JMA. Atypical presentation of acute and chronic coronary artery disease in diabetics. World J Cardiol . 2014;6(8):802–13. DOI.org/10.4330/wjc.v6.i8.802
Prasad DS, Kabir Z, Revathi Devi K, Peter PS, Das BC. Prevalence and Risk factors for Silent Myocardial ischemia (PRISM): A clinico observational study in patients of type 2 diabetes. Indian Heart J. 2019;71(5):400–5. DOI.org/10.1016/j.ihj.2019.12.002
Baweja PS, Sandesara PB, Ashraf MJ. Asymptomatic coronary artery disease in type II diabetes. Mo Med. 2014;111(1):73–9. PMID: 24645303
Young LH, Wackers FJT, Chyun DA, Davey JA, Barrett EJ, Taillefer R, et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial: The DIAD study: A randomized controlled trial. JAMA . 2009;301(15):1547–55. DOI.org/10.1001/jama.2009.476
Sheikh A, Faisal SS, Jabbar A. Frequency of silent myocardial ischaemia in diabetics: a single centre study. J Pak Med Assoc. 2011;61(10):1037–41. PMID: 22356050
Singleton MJ, German CA, Bertoni AG, Ambrosius WT, Bhave PD, Soliman EZ, et al. Association of silent myocardial infarction with major cardiovascular events in diabetes: The ACCORD trial. Diabetes Care . 2020;43(4):e45–6. DOI.org/10.2337/dc19-2201
Vahatalo JH, Huikuri HV, Holmstrom LTA, Kentta TV, Haukilahti MAE, Pakanen L, et al. Association of silent myocardial infarction and sudden cardiac death. JAMA Cardiol. 2019;4(8):796–802. DOI.org/10.1001/jamacardio.2019.2210.
Valensi P, Meune C. Congestive heart failure caused by silent ischemia and silent myocardial infarction: Diagnostic chellenge in type 2 diabetes. Herz. 2019;44(3):210–7. DOI.org/10.1007/s00059-019-4798-3
Vigili de Kreutzenberg S, Solini A, Vitolo E, Boi A, Bacci S, Cocozza S, et al. Silent coronary heart disease in patients with type 2 diabetes: application of a screening approach in a follow-up study. J Diabetes Complications. 2017;31(6):952–7. DOI.org/10.1016/j.jdiacomp.2017.03.014
Tavares CAF, Wajchjenberg BL, Rochitte C, Lerario AC. Screening for asymptomatic coronary artery disease in patients with type 2 diabetes mellitus. Arch Endocrinol Metab. 2016;60(2):143–51. DOI.org/10.1590/2359-3997000000170
Sharda M, Soni AK, Meena S, Nigam H, Singh A. A prospective study on utility of exercise treadmill test in type 2 diabetes mellitus patients. J Assoc Physicians India. 2016;64(11):32–PMID: 27805331
Al-Humaidi G, Sarikaya I, Elgazzar AH, Owunwanne A. Myocardial perfusion abnormalities in asymptomatic type 2 diabetic patients. J Saudi Heart Assoc. 2018;30(1):3–DOI.org/10.1016/j.jsha.2017.04.006
Kishko O. Prevalence of silent myocardial ischemia in middle-aged patients with type 2 diabetes mellitus.
Zellweger MJ, Maraun M, Osterhues HH, Keller U, Müller-Brand J, Jeger R, et al. Progression to overt or silent CAD in asymptomatic patients with diabetes mellitus at high coronary risk: main findings of the prospective multicenter BARDOT trial with a pilot randomized treatment substudy. JACC Cardiovasc Imaging. 2014;7(10):1001–10. DOI.org/10.1016/j.jcmg.2014.07.010
Lievre MM, Moulin P, Thivolet C, Rodier M, Rigalleau V, Penfornis A, et al. Detection of silent myocardial ischemia in asymptomatic patients with diabetes: results of a randomized trial and meta-analysis assessing the effectiveness of systematic screening. Trials. 2011;12(1):23. DOI.org/10.1186/1745-6215-12-23.