Issue 118 Item 7 Predicting Coronary Events in Patients With Diabetes

Silent myocardial ischemia was the strongest independent predictor of future coronary heart disease events A group of researchers led by Dr Rutter from the University of Newcastle upon Tyne, UK, studied the association between baseline silent myocardial ischemia and microalbuminuria with future coronary heart disease events in patients with type 2 diabetes. The study included 86 patients with no history of coronary heart disease who were followed for a mean of 2.8 years.

The researchers showed that 52% of patients had silent myocardial ischemia during treadmill exercise testing, and at follow-up there had been 23 coronary events in 15 patients. After univariate regression analysis, coronary heart disease events were associated with baseline myocardial ischemia (p=0.020), microalbuminuria (p=0.046), ankle-brachial index (p=0.014), fibrinogen (p=0.026)and 10-year Framingham coronary heart disease risk >30% (p=0.035).

After multivariate regression analysis, silent myocardial ischemia was the strongest independent predictor of future coronary heart disease events (p=0.008) and showed higher sensitivity and positive predictive value than microalbuminuria or the Framingham calculated coronary heart disease risk

The authors suggest that baseline silent myocardial ischemia and microalbuminuria may be valuable for risk stratification in patients with type 2 diabetes. Journal of the American College of Cardiology 2002;40:56-61