Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population.

Abstract

The prevalence of ischemic heart disease (IHD) in older adults by glucose tolerance status was evaluated in 2,223 white men and women, aged 50-89 years, in the Rancho Bernardo cohort who were studied between 1984 and 1987. Impaired glucose tolerance (IGT) and noninsulin-dependent diabetes mellitus (NIDDM) were classified according to World Health Organization criteria. End points of ischemic heart disease were defined by Rose Questionnaire and resting electrocardiogram (ECG) according to the Minnesota Code. IHD by electrocardiographic changes was classified as asymptomatic (without history of chest pain or overt IHD) or symptomatic (with history). IHD by all criteria combined was significantly more common in men and women with NIDDM, and in women with IGT, than in those with normal glucose tolerance. The prevalence of myocardial infarction, defined by major Q wave, Rose Questionnaire chest pain criteria, or personal history, was higher in persons with NIDDM than in persons without; the difference was highly significant in women (odds ratio, 2.08 [1.22, 3.56]; p=0.09). Angina pectoris was not significantly related to NIDDM or IGT in either sex. Electrocardiographic evidence of asymptomatic IHD was significantly more prevalent in both men and women with NIDDM as compared with those with normal glucose tolerance (odds ratios, 1.75 [1.10, 2.81] for men and 1.80 [1.07, 3.01] for women; p<0.05). This significant association persisted after excluding persons on digitalis or diuretic therapy and, in women, was also independent of the effect of major known IHD risk factors. These population-based data are consistent with clinical reports suggesting an association of diabetes with silent myocardial infarction or ischemia. The presence of ischemic resting electrocardiographic abnormalities in the asymptomatic diabetic patient is likely to have prognostic and therapeutic implications. (Circulation 1990;81:899-906) Over the past 25 years, an excess risk of ischemic heart disease (IHD) morbidity and mortality has been observed consistently in diabetics of Western societies despite variable study designs and changing diagnostic criteria.1,2 Very few population-based studies have considered both standardized criteria for nonfatal IHD end points and current criteria for non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT).3-5Data are particularly scarce regarding the association of diabetes with painless (silent) myocardial infarction or ischemia although clinical studies have drawn attention to this coincidence.6-8 We report, here, the prevalence of All editorial decisions for this article, including selection of reviewers and the final decision, were made by a guest editor. This procedure applies to all manuscripts with authors from the University of California San Diego or

Silent myocardial infarction and its prognosis in a community-based cohort of Type 2 diabetic patients: the Fremantle Diabetes Study

“…This proportion is greater than in the general population, with most studies reporting that 40% or less of MIs are silent [1,2,3]. As in previous smaller scale studies [8,9], our diabetic patients with silent MI were more likely to be women and hypertensive. They were also less likely to have smoked and more likely to have had favourable serum lipid profiles.…”

“…Major Q waves are an important marker of unrecognised cardiac disease [10] but the limitations of using only a resting ECG in CHD classification have been acknowledged [1,9]. Coding errors can also confound analysis of ECG data.…”

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

“…Similarly, in the diabetic subjects of the Framingham cohort, the relative risk of angina pectoris was comparable to the risk of other manifestations of coronary artery disease (9). In a crosssectional study from California, resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease were associated with non-insulin-dependent diabetes mellitus (10). On the other hand, there are at least three other large studies suggesting that the increase in the prevalence or incidence of symptomatic coronary artery disease is similar to that in ischemic electrocardiographic abnormalities in the diabetic population (11)(12)(13).…”

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

“…There are at least four other large studies suggesting that the increase in the prevalence or incidence of symptomatic coronary artery disease in diabetic patients is not lower than the increase in ischaemic electrocardiographic abnormalities [50±53]. Only in a cross-sectional study in California were resting electrocardiographic abnormalities suggestive of asymptomatic ischaemic heart disease associated with non-insulin-dependent diabetes mellitus [54]. Thus, indirect evidence from clinical studies and epidemiological surveys suggest that the increase in the prevalence of asymptomatic coronary artery disease in diabetic subjects does not differ significantly from the increase in the symptomatic forms of the disease but could be a consequence of accelerated atherosclerosis in diabetes.…”