Predictive value of silent myocardial ischemia for cardiac events in diabetic patients: influence of age in a French multicenter study.
OBJECTIVE
Silent myocardial ischemia (SMI) in asymptomatic subjects with no history of myocardial infarction or angina is a frequent condition in diabetic patients. The aim of the study was to examine the predictive value of SMI for cardiac events in a multicenter cohort and to determine whether this value is higher in patients with a particular clinical profile.


METHODS
A total of 370 asymptomatic diabetic patients with at least two additional cardiovascular risk factors was recruited in four departments of diabetology. SMI was assessed by either exercise or dipyridamole single-photon emission-computed tomography myocardial perfusion imaging with thallium-201. If dipyridamole stress was used, an electrocardiogram stress test was performed separately on another day. Follow-up duration was 3-89 months (38 +/- 23 months).


RESULTS
There was evidence of SMI in 131 patients (35.4%) on at least one positive noninvasive test. The patients with SMI were significantly older and had significantly higher serum triglycerides and lower HDL cholesterol levels. Cardiac events occurred in 53 patients (14.3%). Major cardiac events (death or myocardial infarction) occurred in 38 patients (10%) and other events (unstable angina, heart failure, or coronary revascularization) occurred in 15 patients. The patients who had cardiac events were older and had higher serum triglyceride levels at baseline. There was a significant association between SMI and cardiac events (hazard ratio 2.79 [95% CI 1.54-5.04]) and in particular major cardiac events (3 [1.53-5.87]). In the patients >60 years of age, the prevalence of SMI was higher (43.4 vs. 30.2% in those <60 years). SMI was associated with a significant risk of cardiac events (2.89 [1.31-6.39]) and in particular major cardiac events (3.66 [1.36-9.87]) for the patients >60 years old but not for those <60 years old.


CONCLUSIONS
In asymptomatic diabetic patients with additional cardiovascular risk factors, SMI is a potent predictor of cardiac events and should be assessed preferably in the patients >60 years of age.
Valensi
Paul
P
Department of Endocrinology-diabetology-Nutrition, Jean Verdier Hospital, Bondy Cedex, France. paul.valensi@jvr.ap-hop-paris.fr
Pariès
Jacques
J
Brulport-Cerisier
Valérie
V
Torremocha
Florence
F
Sachs
Régis-Nessim
RN
Vanzetto
Gérald
G
Cosson
Emmanuel
E
Lormeau
Boris
B
Attali
Jean-Raymond
JR
Maréchaud
Richard
R
Estour
Bruno
B
Halimi
Serge
S
D000375:Aging; D000465:Algorithms; D016009:Chi-Square Distribution; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000517:prevention & control; D004176:Dipyridamole; D005080:Exercise Test; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014280:Triglycerides / Q000097:blood; D014665:Vasodilator Agents
D008076:Cholesterol, HDL; D013794:Thallium Radioisotopes; D014280:Triglycerides; D014665:Vasodilator Agents; D004176:Dipyridamole