Asymptomatic Myocardial Ischemia in Diabetes and Its Relationship to Diabetic Neuropathy: An Exercise Electrocardiography Study in Middle-Aged Diabetic Men

Hume, L.; Oakley, Godfrey P.; Aj, Boulton; Hardisty, C. A.; Ward, John D.

doi:10.2337/diacare.9.4.384

Cited by 51 publications

(26 citation statements)

References 7 publications

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“…The findings of Nesto et al (30) are in agreement with those of Hume et al (15), who demonstrated that an abnormal exercise electrocardiogram is no more common in asymptomatic diabetic patients with peripheral or autonomic neuropathy than in those without.…”

Section: Diabetic Autonomic Neuropathy and Silentsupporting

confidence: 82%

“…Detailed data were also obtained on the coronary anatomy of the patients, showing the asymptomatic diabetic patients to have a milder coronary artery disease compared with the symptomatic ones. Unfortunately, the above-mentioned investigations into silent ischemia in diabetic patients had no data on the coronary anatomy (15,30,39).…”

Section: Diabetic Autonomic Neuropathy and Silentmentioning

confidence: 99%

See 1 more Smart Citation

Association Between Silent Coronary Artery Disease, Diabetes, and Autonomic Neuropathy: Fact or Fallacy?

Airaksinen

Koistinen

1992

Diabetes Care

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Section: Diabetic Autonomic Neuropathy and Silentsupporting

confidence: 82%

Section: Diabetic Autonomic Neuropathy and Silentmentioning

confidence: 99%

Association Between Silent Coronary Artery Disease, Diabetes, and Autonomic Neuropathy: Fact or Fallacy?

Airaksinen

Koistinen

1992

Diabetes Care

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“…Another study [61] found a high incidence of silent ischaemia in diabetic patients but the proportion among the diabetic patients with minimal autonomic nervous system dysfunction and those with more extensive autonomic neuropathy was similar. Two other studies [62,63] failed to show an association between abnormalities in conventional autonomic function tests and silent myocardial ischaemia or asymptomatic coronary artery disease but the symptomatic patients had more severe coronary artery disease [63]. Furthermore, Nesto et al [35] found no association between silent ischaemia and peripheral neuropathy but the development of peripheral and autonomic neuropathy is not always concordant in patients with non-insulin-dependent diabetes [64].…”

Section: Association Of Diabetic Autonomic Neuropathy With Silent Myomentioning

confidence: 99%

Silent coronary artery disease in diabetes - a feature of autonomic neuropathy or accelerated atherosclerosis?

Airaksinen

2001

Diabetologia

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It is generally accepted that diabetic patients with acute myocardial infarction often present with atypical symptoms and the infarction can be completely painless. Autonomic damage is regarded as the cause for the blunted appreciation of pain during acute coronary events, but both of these contentions are open to discussion. The purpose of this paper is to evaluate critically the information available on these relations. Silent myocardial infarction in patients with diabetesThe concept that silent myocardial infarction is a characteristic of coronary artery disease in the presence of diabetes was originally based on the early report of Bradley and Schonfeld [l]. They found that diabetic patients who were admitted to hospital for myocardial infarction more often had little or no pain during infarction than non-diabetic patients. There is also a necropsy study of 61 patients suggesting that unrecognized myocardial infarction is more common in diabetic subjects [2]. These studies based on hospital and necropsy records cannot definitely prove, however, that painless myocardial infarction is more common in the whole diabetic population because the results could be modified by selection bias. It is reasonable to assume that diabetic patients have a closer medical follow-up and are admitted more readily to hospital for symptoms related to their diabetic status [3], e. g. uncontrolled diabetes, nausea or general weakness. These circumstances could erroneously increase the proportion of painless and atypical infarctions in hospital patients who are diabetic compared with these who are non-diabetic but later reports based on hospital records have failed to show any difference in the frequency of painless acute myocardial infarction between diabetic and non-diabetic patients [3±5].Population-based epidemiological studies are likely to provide more reliable information on the incidence of unrecognized myocardial infarctions in dia- AbstractAsymptomatic coronary artery disease and myocardial infarctions are common in diabetic subjects. The available clinical and epidemiological data suggest that the increased incidence of asymptomatic myocardial infarctions and coronary artery disease in diabetic patients mainly reflects accelerated coronary atherosclerosis and the proportion of silent disease relative to symptomatic disease or episodes is not increased in diabetes. In spite of the theoretical background, there is no convincing clinical or epidemiological evidence that diabetic autonomic neuropathy plays a major part in the lack of ischaemic pain. This is not surprising because the mechanisms of silent myocardial ischaemia are complex and controversial even without diabetes. [Diabetologia (2001) 44: 259± 266]

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“…any studies have investigated the presence of unknown asymptomatic coronary heart disease (CHD) among diabetic subjects (1)(2)(3)(4)(5)(6)(7). Each of these studies has shown, with different rates depending on the diagnostic methods and selection criteria used, increased prevalence rates compared with the general population.…”

mentioning

confidence: 99%

Cardiac Events in 735 Type 2 Diabetic Patients Who Underwent Screening for Unknown Asymptomatic Coronary Heart Disease

et al. 2002

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OBJECTIVE -To report the cardiac events in type 2 diabetic outpatients screened for unknown asymptomatic coronary heart disease (CHD) and followed for 5 years.RESEARCH DESIGN AND METHODS -During 1993, 925 subjects aged 40 -65 years underwent an exercise treadmill test (ETT). If it was abnormal, the subjects then underwent an exercise scintigraphy. Of the 925 subjects, 735 were followed for 5 years and cardiac events were recorded.RESULTS -At the entry of the study, 638 of the 735 followed subjects had normal ETT, 45 had abnormal ETT with normal scintigraphy, and 52 had abnormal ETT and abnormal scintigraphy. The 52 subjects with abnormal scintigraphy and ETT underwent a cardiological and diabetological follow-up; the subjects with just abnormal ETT had a diabetological follow-up only. During the follow-ups, 42 cardiac events occurred: 1 fatal myocardial infarction (MI), 20 nonfatal MIs, and 10 cases of angina in the 638 subjects with normal ETT; 1 fatal MI in the 45 subjects with normal scintigraphy; and 1 fatal MI and 9 cases of angina in the 52 subjects with abnormal scintigraphy. In these 52 subjects all cardiac events were significantly more frequent ( 2 ϭ 21.40, P Ͻ 0.0001) but the ratio of major (cardiac death and MI) to minor (angina) cardiac events was significantly lower (P ϭ 0.002). Scintigraphy abnormality (hazard ratio 5.47; P Ͻ 0.001; 95% CI 2.43-12.29), diabetes duration (1.06; P ϭ 0.021; 1.008 -1.106), and diabetic retinopathy (2.371; P ϭ 0.036; 1.059 -5.307) were independent predictors of cardiac events on multivariate analysis. CONCLUSIONS -The low ratio of major to minor cardiac events in the positive scintigraphy group may suggest, although it does not prove, that the screening program followed by appropriate management was effective for the reduction of risk of major cardiac events.

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Asymptomatic Myocardial Ischemia in Diabetes and Its Relationship to Diabetic Neuropathy: An Exercise Electrocardiography Study in Middle-Aged Diabetic Men

Cited by 51 publications

References 7 publications

Association Between Silent Coronary Artery Disease, Diabetes, and Autonomic Neuropathy: Fact or Fallacy?

Association Between Silent Coronary Artery Disease, Diabetes, and Autonomic Neuropathy: Fact or Fallacy?

Silent coronary artery disease in diabetes - a feature of autonomic neuropathy or accelerated atherosclerosis?

Cardiac Events in 735 Type 2 Diabetic Patients Who Underwent Screening for Unknown Asymptomatic Coronary Heart Disease

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