High incidence of silent myocardial ischemia in elderly patients with non insulin-dependent diabetes mellitus

The present study was designed to reveal the incidence of silent myocardial ischemia in asymptomatic elderly non-insulin-dependent diabetic (NIDDM) pa tients (aged over 60 years). As a first step screening, maximal treadmill e xercise test was performed. Of 140 patients studied, 54 (38.6%) were unable or not expected to achieve diagnostic levels of exercise during treadmill testing. A positive exercise test was noted in 39 of 86 (45.3%) subjects. A s a second step examination, dipyridamole thallium scintigraphy was perform ed for 93 subjects who exhibited a positive exercise test and could not per form a maximal exercise test. Abnormal perfusion pattern was found in 39 of 93 (41.9%), who were finally considered to have a silent myocardial ischem ia. Coronary angiography was performed in 18 subjects with diagnosis of sil ent myocardial ischemia, who gave their consent. Significant coronary arter y stenosis was in fact found in 17 of 18 (94.4%) subjects studied, confirmi ng a very high positive predictive value of this diagnostic procedure. In c onclusion, elderly NIDDM patients (aged over 60 years) had an extremely hig h prevalence (estimated 26.3%) of silent myocardial ischemia. This evidence suggests that early and intensive detection may be needed as a part of rou tine care for this group. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.