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Silent Myocardial Ischemia in Middle-Aged Asymptomatic Patients With Type 2 Diabetes in Turkish Population
Betul Ugur-Altun, MD
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.
References
- Plutzky J., Viberti G., Haffner S.: Atherosclerosis in type 2 diabetes mellitus and insulin resistance: Mechanistic links and therapeutic targets. J Diabetes Complications 16:401-415, 2002.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Kannel WB, McGee DL: Diabetes and cardiovascular disease: The Framingham Study. JAMA 241:2035-2038, 1979.[Abstract/Free Full Text]
- Prineas RJ, Crow RS, Blackburn H.: The Minnesota Code Manual of Electrocardiographic Findings: Standards and Procedures for Measurement and Classification. Littleton, MA, John Wright, 1982.
- Elhendy A., Mahoney DW, Khandheria BK, et al: Prognostic significance of impairment of heart rate response to exercise. Impact of left ventricular function and myocardial ischemia. J Am Coll Cardiol 42:823-830, 2003.[Abstract/Free Full Text]
- Bonora E., Targher G., Alberiche M., et al: Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: Studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 23: 57-63, 2000.[Medline]
[Order article via Infotrieve]
- Emoto M., Nishizawa Y., Maekawa K., et al: Homeostasis model assessment as a clinical index of insulin resistance in type 2 diabetic patients treated with sulfonylureas. Diabetes Care 22:818-822, 1999.[Abstract/Free Full Text]
- Katsuki A., Sumida Y., Gabazza EC, et al: Homeostasis model assessment is a reliable indicator of insulin resistance during follow-up of patients with type 2 diabetes. Diabetes Care 24:362-365, 2001.[Abstract/Free Full Text]
- Mather KJ, Hunt AE, Steinberg HO, et al: Repeatability characteristics of simple indices of insulin resistance: Implications for research applications. J Clin Endocrinol Metab 86:5457-5464, 2001.[Abstract/Free Full Text]
- Satman I., Yilmaz T., Sengul A., et al: Population-based study of diabetes and risk characteristics in Turkey: Results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care 25:1551-1556, 2002.[Abstract/Free Full Text]
- Inoguchi T., Yamashita T., Umeda F., et al: High incidence of silent myocardial ischemia in elderly patients with non-insulin dependent diabetes mellitus. Diabetes Res Clin Pract 47:37-44, 2000.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Paillole C., Ruiz J., Juliard JM, et al: Detection of coronary artery disease in diabetic patients. Diabetologia 38:726-731, 1995.[Web of Science][Medline]
[Order article via Infotrieve]
- Janand-Delenne B., Savin B., Habib G., et al: Silent myocardial ischemia in patients with diabetes: Who to screen. Diabetes Care 22:1396-1400, 1999.[Abstract/Free Full Text]
- Weiner DA, Ryan TJ, Parsons L., et al: Significance of silent myocardial ischemia during exercise testing in patients with diabetes mellitus: A report from the Coronary Artery Surgery Study (CASS) registry. Am J Cardiol 68:729-734, 1991.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Rutter MK, Wahid ST, McComb JM, et al: Significance of silent ischemia and microalbuminuria in predicting coronary events in asymptomatic patients with type 2 patients. J Am Coll Cardiol 40:56-61, 2002.[Abstract/Free Full Text]
Angiology, Vol. 58, No. 5,
535-542 (2007)
DOI: 10.1177/0003319707307765
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