PREVALENCE OF UNRECOGNIZED SILENT-MYOCARDIAL-ISCHEMIA AND ITS ASSOCIATION WITH ATHEROSCLEROTIC RISK-FACTORS IN NONINSULIN-DEPENDENT DIABETES-MELLITUS

To determine the prevalence of unrecognized silent myocardial ischemia , 925 noninsulin-dependent diabetic outpatients (333 women and 592 men ), aged 40 to 65 years, asymptomatic, free from known coronary artery disease (CAD), advanced diabetic retinopathy, and nephropathy, severe hypertension, and poor prognosis disease, underwent exercise electroca rdiogram (ECG), followed, if abnormal, by an exercise thallium scintig raphy. The exercise ECG tests were abnormal in 112 patients (12.1%, 31 women, 81 men), of whom 59 (6.4%, 12 women, 47 men) had perfusion def ects at thallium scintigraphy. Adopting the more restrictive criteria (positive response to both tests) the prevalence of silent CAD resulte d in 6.4%. Multivariate analysis showed that in the whole population a nd in the men, the associated independent risk factors were age, total cholesterol, proteinuria, and ST-T abnormalities at ECG at rest. This last factor had the highest odds ratio (9.27, confidence interval [CI ] 4.44 to 19.38) and was the only one identified also in women, The re levance of ST-T abnormalities at ECG at rest as a predicting factor fo r silent CAD outlines the importance of a periodical ECG at rest in no ninsulin-dependent diabetic patients and suggests an indication of per formance of further investigations in presence of these abnormalities. (C) 1997 by Excerpta Medico, Inc.