Document Detail


Intensive cardiovascular risk factors therapy and prevalence of silent myocardial ischaemia in patients with type 2 diabetes.
MedLine Citation:
PMID:  19041838     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Screening for silent myocardial ischaemia (SMI) is a controversial strategy undergoing intensive risk factor therapy.
AIMS: To assess the prevalence of SMI and coronary artery disease (CAD) in asymptomatic type 2 diabetic patients at high cardiovascular risk (two additional risk factors or more) and undergoing long-term intensive risk factor therapy and tight glycaemic control.
METHODS: SMI screening, using isotopic or echographic stress tests, was carried out in 122 asymptomatic type 2 diabetic patients at high cardiovascular risk and undergoing long-term intensive risk factor therapy. Coronary angiography was proposed if SMI was detected. Long-term follow-up data on death, myocardial infarction and revascularization were obtained by telephone call or clinical review.
RESULTS: The mean age was 65+/-6 years and 74% of patients were men. The mean duration of diabetes was 15+/-9 years. The mean number of additional risk factors was 2.9, 32% of patients had microalbuminuria and 12% had peripheral arterial disease. SMI was detected in 20 (16%) patients. Seven (6%) patients had significant CAD treated successfully by angioplasty (n=6) or bypass surgery (n=1). The positive predictive value of the non-invasive screening test for the diagnosis of significant CAD (stenosis>50%) was 39%. The event rate was very low (1.6%) at 2-year follow-up.
CONCLUSION: Long-term intensive risk factor therapy in high-risk patients with type 2 diabetes is associated with low prevalence of SMI and detected CAD. Optimal medical therapy and revascularization of significant CAD are associated with a low cardiovascular event rate at two years.
Authors:
Olivier Barthelemy; Sophie Jacqueminet; Francois Rouzet; Richard Isnard; Anissa Bouzamondo; Dominique Le Guludec; André Grimaldi; Jean-Philippe Metzger; Claude Le Feuvre
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Publication Detail:
Type:  Journal Article     Date:  2008-09-23
Journal Detail:
Title:  Archives of cardiovascular diseases     Volume:  101     ISSN:  1875-2136     ISO Abbreviation:  Arch Cardiovasc Dis     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-12-01     Completed Date:  2009-01-30     Revised Date:  2011-04-25    
Medline Journal Info:
Nlm Unique ID:  101465655     Medline TA:  Arch Cardiovasc Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  539-46     Citation Subset:  IM    
Affiliation:
Département de cardiologie médicale, institut de cardiologie, groupe hospitalo-universitaire Pitié-Salpêtrière, 47 et 83, boulevard de l'Hôpital, 75651 , Paris cedex 13, France. Olivier.barthelemy@psl.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
Coronary Angiography
Coronary Artery Disease / epidemiology*,  etiology,  pathology,  therapy
Diabetes Complications / epidemiology*,  etiology,  pathology
Diabetes Mellitus, Type 2 / complications,  drug therapy,  epidemiology*,  pathology
Echocardiography, Stress
Female
Humans
Male
Middle Aged
Myocardial Ischemia / epidemiology*,  etiology,  pathology,  prevention & control
Practice Guidelines as Topic
Predictive Value of Tests
Prevalence
Prospective Studies
Risk Factors
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
Arch Cardiovasc Dis. 2008 Sep;101(9):509-11   [PMID:  19041833 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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