Prasad D S, Kabir Zubair, Revathi Devi K, Peter Pearline Suganthy, Das B C
Sudhir Heart Centre, Berhampur, 760002, Odisha State, India.
School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland.
Indian Heart J. 2019 Sep-Oct;71(5):400-405. doi: 10.1016/j.ihj.2019.12.002. Epub 2019 Dec 23.
To estimate the prevalence and to identify potential risk factors of silent myocardial ischemia in a cohort of patients with asymptomatic type 2 Diabetes (diabetes) for early detection of coronary risk by employing objective noninvasive clinical screening tools for Subclinical Atherosclerosis.
The study is a clinic-based observational study on 338 consecutive diabetes patients attending an urban health center from Eastern India. The response rate was 96.57% out of 350 eligible subjects, comprising 176 (52.1%) males and 162 (47.9%) females. Clinical, anthropometric, biochemical parameters were collected in all participants. Both tools, i.e., treadmill test (TMT) to identify subjects with silent myocardial ischemia, and carotid imaging to detect subclinical atherosclerosis by evaluating carotid intima-media thickness (CIMT), were assessed. Significant determinants were predicted by multivariable logistic regression.
The study group was divided into a TMT negative (n = 260), and a TMT positive group (n = 78). These 78 TMT positive subjects (23.1%) were identified to have silent myocardial ischemia. The prevalence of silent myocardial ischemia was more common in males (28.4%) than in females (17.3%). The mean CIMT in our study group was 0.6741 ± 0.034 mm (males - 0.684 ± 0.034 mm and females - 0.663 ± 0.032 mm). Age ≥50 years, CIMT ≥0.70 mm, hypercholesterolemia, and hypertriglyceridemia were significant determinants for identifying asymptomatic diabetics at risk for silent myocardial ischemia.
Silent myocardial ischemia is highly prevalent at about one in four asymptomatic diabetic patients. An increased CIMT can be a surrogate marker of higher coronary risk amongst these asymptomatic diabetics.
通过采用客观的亚临床动脉粥样硬化无创临床筛查工具，评估无症状2型糖尿病（糖尿病）患者队列中无症状心肌缺血的患病率，并确定其潜在危险因素，以早期发现冠状动脉风险。
本研究是一项基于临床的观察性研究，对来自印度东部一家城市健康中心的338例连续糖尿病患者进行研究。在350名符合条件的受试者中，应答率为96.57%，其中男性176例（52.1%），女性162例（47.9%）。收集了所有参与者的临床、人体测量和生化参数。评估了两种工具，即用于识别无症状心肌缺血患者的平板运动试验（TMT），以及通过评估颈动脉内膜中层厚度（CIMT）来检测亚临床动脉粥样硬化的颈动脉成像。通过多变量逻辑回归预测显著的决定因素。
研究组分为TMT阴性组（n = 260）和TMT阳性组（n = 78）。这78名TMT阳性受试者（23.1%）被确定患有无症状心肌缺血。无症状心肌缺血的患病率在男性（28.4%）中比女性（17.3%）更常见。我们研究组的平均CIMT为0.6741±0.034 mm（男性 - 0.684±0.034 mm，女性 - 0.663±0.032 mm）。年龄≥50岁、CIMT≥0.70 mm、高胆固醇血症和高甘油三酯血症是识别有无症状心肌缺血风险的无症状糖尿病患者的显著决定因素。
无症状心肌缺血在约四分之一的无症状糖尿病患者中高度普遍。CIMT增加可能是这些无症状糖尿病患者中冠状动脉风险较高的替代标志物。
