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Silent Myocardial Ischemia in Middle-Aged Asymptomatic Patients With Type 2 Diabetes in Turkish Population

Department of Endocrinology and Metabolism, Trakya University, Edime, Turkey, habeug{at}yahoo.com

Armagan Altun, MD, FESC

Cardiology, Medical School, Trakya University, Edirne, Turkey

Sibel Guldiken, MD

Department of Endocrinology and Metabolism, Trakya University, Edime, Turkey

Ersan Tatli, MD

Cardiology, Medical School, Trakya University, Edirne, Turkey

Mujdat Kara, MD

Department of Endocrinology and Metabolism, Trakya University, Edime, Turkey

Armagan Tugrul, MD

Department of Endocrinology and Metabolism, Trakya University, Edime, Turkey

The authors investigated silent myocardial ischemia in unselected consecutive middle-aged asymptomatic patients with type 2 diabetes without any evidence of coronary heart disease documented by treadmill exercise test. Ninety asymptomatic patients with type 2 diabetes (48 men; mean age: 49 ±6 years) were included in the study. Mean duration of diabetes in the study group was 4 ±4.2 years (range 1 to 21 years); 38% of the study population, diabetes duration was only 1 year). All patients were subjected to treadmill exercise test with Bruce protocol. A positive test was noted in 4 of 90 (4%) study patients. Two male patients (4%) and 2 (4%) women patients developed exercise-induced ST-segment depression, but none had concomitant chest pain. Diabetics with silent myocardial ischemia were older (55 ±3 years vs 49 ±6 years, p = 0.04) than those without silent myocardial ischemia. Also, diabetics with silent myocardial ischemia had higher fibrinogen level (372 ±51 vs 307 ±71 mg/dL, p = 0.04) than diabetics without silent myocardial ischemia. In treadmill exercise test, diabetics with silent myocardial ischemia had lower total exercise time and peak workload (375 ±30 vs 474 ±115 seconds, p = 0.04; 7.3 ±0.5 vs 8.9 ±1.9, p = 0.04, respectively) than without silent myocardial ischemia. Insulin resistance is associated with a variety of atherosclerosis risk factors. Exercise test findings show increased cardiac sympathetic activity and parasympathetic withdrawal in increased insulin resistance.

Angiology, Vol. 58, No. 5, 535-542 (2007)
DOI: 10.1177/0003319707307765


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