Silent coronary artery disease inpatients with type 2 diabetes mellitus

Abstract. The purpose of this study was to estimate the prevalenceand risk factors of silent CAD in asymptomatic type 2 diabeticpatients aged over 40 years. A total of 172 asymptomatic type 2diabetic patients, mean age 54.42 years, with normal restingelectrocardiogram were included in the study. Technetium-99m(Tc-99m) tetrofosmin cardiac single photon emission computedtomography myocardial scintigraphy with exercise testing ordipyridamole injection was performed on all patients. If thistest was positive, coronary angiography was carried out and wasconsidered to be positive with a stenosis of 70%. Abnormalperfusion pattern was found in 14 patients (8.14%). Significantcoronary artery stenosis was found in 13 subjects (7.56%),confirming a high positive predictive value (92.86%) of thisdiagnostic procedure. A significant correlation was observedbetween silent CAD and male sex, retinopathy, hypertension,post-prandial blood glucose level, and low HDL-cholesterollevel. Sex (OR=4.026; 95% CI, 1.187–13.659), hypertension(OR=5.564; 95% CI, 1.446–21.400) and retinopathy (OR=3.766; 95%CI, 1.096–12.948) were risk factors for CAD. Overall, 14.06% ofasymptomatic male patients with type 2 diabetes mellituspresented silent CAD with significant angiographicallydocumented coronary stenosis. This finding, along with the highpositive predictive value of a noninvasive technique, indicatesthat routine screening for silent CAD would be useful in thispatient subgroup especially when they have retinopathy orhypertension.