Exercise stress test for the detection of silent myocardial ischemia in diabetic patients

Abstract

Coronary artery disease (CAD) in patients with diabetes mellitus (DM) is diagnosed late in part due to silent myocardial ischemia (SMI). The aim of this study were to evaluate cardiovascular risk factors and the frequency of SMI in patients with DM. One-hundred and twenty-five individuals were studied: 42 diabetic hypertensive patients (group 1), 22 diabetic normotensive patients (group 2); 32 non-diabetic hypertensive patients (group 3) and 29 non-diabetic normotensive individuals (group 4). Data on DM duration, family history for coronary disease, cigarette smoking, total and HDL cholesterol, triglycerides, creatinine and urinary albumin-urinary creatinine ratio were obtained. Cardiovascular evaluation and exercise stress test (EST) were performed for all subjects. Mean body mass index was similar in the 4 groups. Values of total cholesterol were 207±38 mg/dL, 231±35 mg/dL, 214±47 mg/dL, 216±51 mg/dL (ns); HDL-cholesterol: 47±13 mg/dL, 42±7 mg/dL, 41±8 mg/dL, 48±15 mg/dL (ns), LDL-cholesterol: 123±36 mg/dL, 165±70 mg/dL, 152±62 mg/dL, 139±48 mg/dL (p<0,05, group 1 and 4 vs groups 2 and 3), triglycerides: 196±175 mg/dL, 164±51 mg/dL, 176±108 mg/dL, 158±68 mg/dL (ns), in groups 1, 2, 3 and 4, respectively. Nineteen subjects (15,5%) had a positive EST for myocardial ischemia. Among them, 14(73,7%) were from group 1. The high frequency of SMI observed in diabetic hypertensive patients suggests that EST should be considered as a routine test for evaluation of this high-risk population. Key words: Diabetes Mellitus. Myocardial Ischemia. Hypertension.