Ischemia
And Microalbuminuria May Predict Coronary Events in Diabetics
Silent
myocardial ischemia was the most sensitive predictor of coronary events
In
patients with type 2 diabetes who are asymptomatic for coronary heart
disease, the presence of silent myocardial ischemia (SMI) and
microalbuminuria (MA) at baseline may predict future coronary events,
according to a report published in the July 3rd issue of the Journal
of the American College of Cardiology.
Coronary
heart disease is the number one cause of death in patients with type 2
diabetes. In this population, heart disease often presents without
warning as myocardial infarction, heart failure, or even sudden death.
Therefore, to allow therapeutic intervention, tests are needed that
can predict which patients are at increased risk for coronary events.
SMI
and MA have previously been identified as risk factors for
cardiac-related mortality, but their predictive value in asymptomatic
patients with type 2 diabetes has been unclear.
In
the current study, Dr. Martin K. Rutter, from The Lahey Clinic in
Burlington, Massachusetts, and colleagues assessed the prognostic
value of SMI and MA in 86 patients with type 2 diabetes and no history
of coronary heart disease. The group included 43 patients with MA
individually matched to 43 patients without MA. The patients were
followed for nearly 3 years.
Treadmill
testing at baseline revealed that 45 patients had SMI, the authors
note. During the study period, 15 patients experienced a total of 23
coronary events.
On
univariate analysis, baseline ankle brachial index, SMI, MA, 10-year
Framingham heart disease risk >30%, and fibrinogen level were all
identified as predictors of coronary events. However, on multivariate
analysis, only SMI and ankle brachial index were independent
predictors of coronary events.
SMI
was the most sensitive predictor of events, the researchers state.
Still, combining SMI and MA results allowed the researchers to
identify patients at particularly high and low risk for coronary
events.
The
findings suggest that "SMI, MA and ankle brachial index could be
of practical value in risk stratification," the investigators
note. "Future studies should aim to determine appropriate risk
thresholds for initiation of anti-ischemia therapy and for CHD
screening to identify those who are likely to benefit from
revascularization." J Am Coll
Cardiol 2002;40:56-61.
