Presentation and symptom predictors of coronary heart disease in patients with and without diabetes

The aims of this prospective, observational study were to compare: (1) symp tom presentation of coronary heart disease (CHD) between patients with and without diabetes and (2) symptom predictors of CHD in patients with and wit hout diabetes. We directly observed 528 patients with symptoms suggestive o f CHD as they presented to the ED of a 900-bed cardiac referral center in t he northeastern United States. There were no significant differences in sym ptom presentation of CHD between patients with and without diabetes, althou gh patients with diabetes were slightly more likely to present with shortne ss of breath (P = .056). Patients with diabetes reported their symptoms to be more severe compared with those without diabetes (P = .036). Neck/throat pain and arm/shoulder pain were of borderline significance in predicting C HD in patients with diabetes (P = .059 and P = .052, respectively). Classic chest symptoms and diaphoresis were independent predictors of CHD in patie nts without diabetes (P = .002 and P = .049, respectively). The perceived s everity of symptoms was not predictive of CHD in patients with or without d iabetes. Symptoms thought to be diagnostic of CHD are not helpful in patien ts with diabetes. Future research should focus on identifying more useful p redictors of CHD in patients with diabetes. Copyright (C) 2001 by W.B. Saun ders Company.