ASYMPTOMATIC CORONARY-ARTERY DISEASE IN DIABETES - ASSOCIATED WITH AUTONOMIC NEUROPATHY

To elucidate the potential association of diabetic autonomic neuropath y with increased prevalence of silent coronary artery disease (CAD), 1 38 asymptomatic diabetic subjects were screened using exercise ECG. 24 -h ambulatory ECG and dynamic thallium scintigraphy. Fourteen patients with exercise-induced myocardial ischaemia and angiographically confi rmed CAD (greater-than-or-equal-to 50% coronary artery narrowing) were found using this protocol. Their autonomic nervous function was asses sed using standard cardiovascular tests and compared with that of 23 c onsecutive diabetic patients catheterised because of symptomatic CAD ( mean New York Heart Association class 3.0). The diabetic patients with symptomatic CAD had more severe coronary atherosclerosis than the dia betic patients with asymptomatic CAD assessed by jeopardy score (P < 0 .01). The groups did not, however, differ with respect to autonomic fu nction tests. Five patients (22%) with symptomatic CAD and 3 patients (21 %) with asymptomatic CAD had definite autonomic dysfunction, i.e. two or more abnormal tests. Thus, our results suggest that the frequen cy of autonomic neuropathy is not increased in diabetic patients with asymptomatic CAD. The contribution of diabetic autonomic neuropathy to the absence of cardiac pain needs further clinical and pathological s tudies.