Silent Cardiac Ischemia in Type II Diabetes Mellitus: Prevalence, Risk Factors, and Predictors in 205 Patients

• SYED MAHMOOD-UL-HASSAN

  Assistant Professor of medicine , Medical Unit 01 , Services Hospital , Lahore

  Author

• MUHAMMAD IMRAN

  Consultant physician , Medical unit 2 , Services hospital , Lahore

  Author

• MUHAMMAD USMAN GHANI

  MBBS , FCPS Medicine Senior Registrar , Medical Unit 01 , Services Hospital lahore

  Author

Background: Silent cardiac ischemia (SCI) is a common but underdiagnosed cardiovascular complication in patients with type II diabetes mellitus (T2DM). SCI increases the risk of adverse cardiovascular events due to its asymptomatic nature.

Objective: To determine the prevalence and risk factors of SCI in T2DM patients and identify independent predictors using logistic regression analysis.

Methods: A cross-sectional study was conducted on 205 asymptomatic T2DM patients. Comprehensive demographic, clinical, and laboratory data were collected. Patients underwent exercise treadmill testing using the Bruce protocol, with myocardial perfusion imaging for inconclusive cases. Logistic regression analysis was performed to identify independent predictors of SCI.

Results: The mean age of participants was 55.8 ± 9.4 years; 112 (54.6%) were male. The mean diabetes duration was 8.6 ± 5.2 years, and the mean HbA1c was 7.8 ± 1.1%. SCI was detected in 67 patients (32.7%). Significant risk factors included older age, male gender, long diabetes duration, poor glycemic control, hypertension, dyslipidemia, and autonomic neuropathy. Logistic regression identified diabetes duration >10 years (OR 2.3, 95% CI 1.2–4.2), autonomic neuropathy (OR 3.1, 95% CI 1.6–6.0), and HbA1c >8% (OR 2.0, 95% CI 1.1–3.8) as independent predictors.

Conclusion: SCI is prevalent in asymptomatic T2DM patients. Long-standing diabetes, poor glycemic control, and autonomic neuropathy are strong predictors. Targeted screening of high-risk patients may enable early intervention and reduce adverse outcomes.

1. American Diabetes Association. Cardiovascular disease and risk management: Standards of medical care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S96–S110.

2. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115(3):387–397.

3. Kosmala W, Przewlocka-Kosmala M, et al. Silent myocardial ischemia in diabetes: Prevalence and diagnostic considerations. J Diabetes Complications. 2008;22:179–184.

4. Haffner SM, Lehto S, Rönnemaa T, et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–234.

5. Pop-Busui R, et al. Cardiac autonomic neuropathy in diabetes: Epidemiology, clinical impact, and management. Diabetes Metab Res Rev. 2009;25:116–125.

6. Balci MK, Aytemir K, et al. Exercise stress testing for detection of silent myocardial ischemia in diabetic patients. Int J Cardiol. 2001;81:61–66.

7. Rutter MK, et al. Silent ischemia in type 2 diabetes: Detection and prognostic significance. Diabetes Care. 2003;26:1046–1051.

8. Bartnik M, et al. Risk factors for silent myocardial ischemia in type 2 diabetes. Diabetes Care. 2001;24:134–139.

9. Tesfaye S, et al. Diabetic neuropathies: Update on definitions, diagnostic criteria, and treatment. Diabetes Care. 2010;33:2285–2293.

10. Morrish NJ, et al. The relationship between cardiovascular risk factors and silent myocardial ischemia in diabetes. Diabetologia. 1998;41:275–282.

11. Stratton IM, et al. Association of glycemia with macrovascular complications in T2DM. BMJ. 2000;321:405–412.

12. Cohn PF. Diabetic coronary artery disease: Clinical manifestations and diagnostic challenges. J Am Coll Cardiol. 2004;43:1564–1571.

13. Haffner SM. Screening for silent ischemia in diabetes: Pros and cons. Diabetes Care. 2000;23:1727–1729.

14. Langer A, et al. Silent myocardial ischemia in diabetes mellitus: Clinical implications. Heart. 2004;90:343–349.

15. Gaede P, et al. Effect of intensive therapy on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2003;348:383–393.

16. Haffner SM. Screening for silent ischemia in diabetes: Pros and cons. Diabetes Care. 2000;23:1727–1729.

17. Langer A, et al. Silent myocardial ischemia in diabetes mellitus: Clinical implications. Heart. 2004;90:343–349.

18. Kosmala W, et al. Silent myocardial ischemia in diabetes: Prevalence and diagnostic considerations. J Diabetes Complications. 2008;22:179–184.

19. Pop-Busui R, et al. Cardiac autonomic neuropathy in diabetes: Epidemiology, clinical impact, and management. Diabetes Metab Res Rev. 2009;25:116–125.

20. Balci MK, et al. Exercise stress testing for detection of silent myocardial ischemia in diabetic patients. Int J Cardiol. 2001;81:61–66.

21. Rutter MK, et al. Silent ischemia in type 2 diabetes: Detection and prognostic significance. Diabetes Care. 2003;26:1046–1051.

22. Bartnik M, et al. Risk factors for silent myocardial ischemia in type 2 diabetes. Diabetes Care. 2001;24:134–139.

23. Morrish NJ, et al. The relationship between cardiovascular risk factors and silent myocardial ischemia in diabetes. Diabetologia. 1998;41:275–282.

24. Tesfaye S, et al. Diabetic neuropathies: Update on definitions, diagnostic criteria, and treatment. Diabetes Care. 2010;33:2285–2293.

25. Gaede P, et al. Effect of intensive therapy on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2003;348:383–393.

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