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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