Issue 172 Item 8 Silent Coronary Artery Disease is Common in Diabetics

Silent myocardial ischemia occurs in about 20% of patients with type 2 diabetes, according to preliminary data from the ongoing Detection of Ischemia in Asymptomatic Diabetics (DIAD) Study.

Dr. Frans Wackers, Yale University School of Medicine, New Haven, Connecticut, reported the findings at the 18th International Diabetes Federation (IDF) Congress.

The results also indicate that myocardial perfusion imaging allows for early identification of silent myocardial ischemia in type 2 diabetics.

The DIAD Study is the first prospective, multi-center investigation to establish the prevalence of silent myocardial ischemia in type 2 diabetics and to attempt to define a high-risk clinical profile.

Subjects include patients with an established diagnosis of type 2 diabetes who range from 50 to 75 years of age and have no known or suspected coronary artery disease and a normal baseline electrocardiogram.

Overall, 1,124 patients were randomized following an initial comprehensive evaluation to stress myocardial perfusion imaging with Cardiolite (Kit for the Preparation of Technetium Tc99m Sestamibi for Injection) plus 5 years of follow-up or to follow-up alone. Prior research has demonstrated that Cardiolite is an accurate predictor of major cardiac events in diabetic patients with established heart disease.

An early analysis of 522 patients who received Cardiolite and in whom imaging data were available showed that 22% had an abnormal Cardiolite test suggesting the presence of silent coronary artery disease.

In patients with abnormal findings, 83 (73%) had an abnormal blood flow; the remaining 26% had other abnormalities that were predominantly ischemic electrocardiogram changes.

"Our results may set the stage for the development of evidence-based guidelines for selectively screening these at-risk patients," Dr. Wackers said. "This, in turn, can potentially permit earlier intervention and thus help many patients avoid premature myocardial infarction or death."

Funding for the study was provided by Bristol-Myers Squibb Medical Imaging, Inc.

IDF: [Study title: Predictors of silent myocardial ischemia in patients with Type 2 diabetes mellitus: results from the DIAD Study. Abstract 60]

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FACT: The number of overweight children ages 6 to 11 has doubled in the last 25 years — the average 11-year-old today weighs 11 pounds more than in 1973. Nearly 65 percent of American adults are now overweight, and the incidence of diabetes doubled between 1980 and 2000, to 12 million cases. American Journal of Public Health