Is silent myocardial infarction more common in women with type 2 diabetes than in men?

Abstract

Objective Our aim was to determine if silent myocardial infarction (MI) is more common in women with type 2 diabetes than in men. Our secondary aim was to examine the relationships between silent MI and risk factors for cardiovascular disease. Research Design and Methods The Action to Control Cardiovascular Risk in Diabetes (ACCORD) database was used to determine if women had more silent MI on baseline electrocardiograms (ECGs) than did men with a similar unremarkable cardiovascular history. MI was diagnosed using ECG analysis according to the Minnesota code. Multivariable logistic regression analysis was used to compare demographic and clinical associations. Interactive effects of risk factors by gender were tested using a forward selection algorithm. Results Men were found to have a higher prevalence of silent MI on baseline ECGs than women (6% vs 4%, p=0.001). Women had lower odds of silent MI than men after adjusting for other risk factors (OR=0.80, p=0.04). Race and ethnicity were significantly associated with silent MI (p=0.02), with Asians having the highest and African Americans and Hispanics having lower odds relative to whites. Conclusions Our main findings provide no evidence that silent MI, as detected by the Minnesota code, was more common in women than in men in the ACCORD cohort. If, as in the general population, the women in ACCORD are found to have a higher heart disease mortality rate than the men, it seems unlikely that failure to recognize clinically silent heart disease in the years before study enrollment could be a major cause.

Recurrent intraoperative silent ST depression responding to phenylephrine

“…[13] Our patient did not have any feature of or predisposing factor for autonomic neuropathy. It has been reported that normal patients perioperatively have higher incidence of silent myocardial ischemia.…”

Silent coronary artery disease in type 2 diabetes: a narrative review on epidemiology, risk factors, and clinical studies

“…In the diabetic population, a greater prevalence of silent MI has been observed in women in the Fremantle [64], and in the UKPDS [33] studies. In the ACCORD cohort no evidence was found that silent MI, as detected by the Minnesota code, was more common in women than in men; rather, women showed a higher heart disease mortality rate compared to men [86]. Usually women complain less of chest pain and of typical symptoms of acute coronary syndrome, especially diabetic women [87,88], but often asymptomatic women have a worse prognosis than asymptomatic males [86,89].…”

Neuropatia Periférica E Sinais Clínicos De Síndrome Coronariana Aguda Em Pacientes Com Diabetes Mellitus

“…Durante todo o acompanhamento, 5% dos indivíduos com NP apresentaram eventos cardiovasculares em comparação com 2,8% de indivíduos sem NP (13) . Pacientes com doença aterosclerótica portadores de DM têm sido sujeitos de diversas pesquisas com o intuito de avaliar a melhor forma de estratificação de risco, com o objetivo de reduzir as complicações na fase aguda (8)(9)(10)(11)(12)(14)(15)(16)(17)(18) . Diante da dificuldade na triagem nos serviços de emergências em pacientes DM, em decorrência da presença de sinais atípicos secundários à neuropatia periférica, são altamente indicados instrumentos que possam facilitar a identificação destas condições ou mesmo estratificar o risco de mortalidade/ complicações destes pacientes.…”