| Silent myocardial ischemia in patients with diabetes: who to screen. | |
| | |
MedLine Citation:
|
PMID: 10480499 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: Silent myocardial ischemia (SMI) is more common in diabetic patients than in the general population. However, the exact prevalence of SMI is not known, and routine screening is costly. The purpose of this 1-year study was to estimate the prevalence of SMI and define a high-risk diabetic population by systematically testing patients with no symptoms of coronary artery disease (CAD). RESEARCH DESIGN AND METHODS: The criteria for inclusion in this study were age (between 25 and 75 years), duration of diabetes (>15 years for type 1 diabetes, 10 years for type 2 diabetes with no cardiovascular risk factors, and 5 years for type 2 diabetes with at least one cardiovascular risk factor), and absence of clinical or electrocardiogram (ECG) symptoms of CAD. For 1 year, 203 patients were screened, including 28 women and 45 men with type 1 diabetes (aged 41.5+/-10.9 years, mean duration of diabetes 20.9+/-7.7 years [mean +/- SD]) and 61 women and 69 men with type 2 diabetes (aged 60.7+/-8.7 years, duration of diabetes 16.5+/-7.1 years). Exercise ECG was the first choice for screening method. If exercise ECG was not possible or inconclusive, thallium myocardial scintigraphy (TMS) with exercise testing and/or dipyridamole injection was performed. If any one of these tests was positive, coronary angiography was carried out and was considered to be positive with a stenosis of > or =50%. RESULTS: Positive screening results were obtained in 32 patients (15.7%). Coronary angiography demonstrated significant lesions in 19 patients (9.3%) and nonsignificant lesions in 7 patients (1 false-positive result for exercise ECG and 6 false-positive results for TMS). Coronary angiography was not performed in six patients. All but 3 of the 19 patients (15 men and 4 women) in whom silent coronary lesions were detected presented with type 2 diabetes. The main differences between the 16 type 2 diabetic patients presenting with coronary lesions and the type 2 diabetic patients without SMI were a higher prevalence of peripheral macroangiopathy (56.2 vs. 15.1%, respectively, P < 0.01) and a higher prevalence of retinopathy (P < 0.05). No correlation was found between SMI and duration of diabetes, HbA1c level, renal status, or cardiovascular risk factors except for family history of CAD. CONCLUSIONS: The results of this study allowed us to determine a high-risk group for SMI in the diabetic population. SMI with significant lesions occurs in 20.9% of type 2 diabetic male patients who are totally asymptomatic for CAD. Based on these findings, we recommend routine screening for male patients in whom the duration of type 2 diabetes is >10 years or even less when more than one cardiovascular risk factor is present. |
| | |
Authors:
|
B Janand-Delenne; B Savin; G Habib; M Bory; P Vague; V Lassmann-Vague |
Related Documents
:
|
23485579 - Alzheimer's disease and insulin resistance: translating basic science into clinical app... 17367889 - The effects of a patient-based risk assessment prompt on diabetes screening. 23448119 - Type 2 diabetes and the evolving paradigm in glucose regulation. 23065369 - Management of hyperglycemia during enteral and parenteral nutrition therapy. 23461799 - Type 1 diabetes structured education: what are the core self-management behaviours? 23623209 - On the importance of global cardiovascular risk assessment in people with type 2 diabetes. 9727899 - Effect of hypoglycemia on beta-adrenergic sensitivity in normal and type 1 diabetic sub... 15093559 - Delayed exposure to wheat and barley proteins reduces diabetes incidence in non-obese d... 21600659 - High serum bilirubin levels and diabetic retinopathy: the hisayama study. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Diabetes care Volume: 22 ISSN: 0149-5992 ISO Abbreviation: Diabetes Care Publication Date: 1999 Sep |
Date Detail:
|
Created Date: 1999-11-10 Completed Date: 1999-11-10 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 7805975 Medline TA: Diabetes Care Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 1396-400 Citation Subset: IM |
Affiliation:
|
Nutrition-Endocrinology-Metabolic Disease Department, Timone University Hospital Center, Marseille, France. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Coronary Angiography Cross-Sectional Studies Diabetes Mellitus, Type 1 / complications Diabetes Mellitus, Type 2 / complications Diabetic Angiopathies / diagnosis*, epidemiology Electrocardiography Female France / epidemiology Humans Male Mass Screening / methods* Middle Aged Myocardial Ischemia / diagnosis*, epidemiology, etiology Prevalence Risk Factors |
| Comments/Corrections | |
Comment In:
|
Diabetes Care. 2000 Sep;23(9):1441-2
[PMID:
10977055
]
Diabetes Care. 2000 Apr;23(4):563-4 [PMID: 10857957 ] Diabetes Care. 1999 Sep;22(9):1393-5 [PMID: 10480498 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Technology in the treatment of voice disorders.
Next Document: Effects of postmenopausal hormone replacement therapy on central abdominal fat, glycemic control, li...