Resolution of asymptomatic myocardial ischemia in patients with type 2 diabetes in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study.
OBJECTIVE
The purpose of this study was to assess whether the prevalence of inducible myocardial ischemia increases over time in patients with type 2 diabetes.


METHODS
Participants enrolled in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study underwent repeat adenosine-stress myocardial perfusion imaging 3 years after initial evaluation. Patients with intervening cardiac events or revascularization and those who were unable or unwilling to repeat stress imaging were excluded.


RESULTS
Of the initial 522 DIAD patients, 358 had repeat stress imaging (DIAD-2), of whom 71 (20%) had ischemia at enrollment (DIAD-1). Of 287 patients with normal DIAD-1 studies, 259 (90%) remained normal in DIAD-2, whereas 28 (10%) developed new ischemia in DIAD-2. Of the 71 patients with abnormal DIAD-1 studies, 56 (79%) demonstrated resolution of ischemia, whereas 15 (21%) remained abnormal. During this 3-year interval, medical treatment was intensified, with more patients using statins, aspirin, and ACE inhibitors than at baseline. Patients with resolution of ischemia had significantly greater increases in these medications than patients who developed new ischemia (P = 0.04).


CONCLUSIONS
Thus, the majority of asymptomatic patients with type 2 diabetes demonstrated resolution of ischemia upon repeat stress imaging after 3 years. This resolution was associated with more intensive treatment of cardiovascular risk factors.
Yale University School of Medicine, Section of Cardiovascular Medicine, 333 Cedar St. Fitkin-3, New Haven, CT 06520, USA. frans.wackers@yale.edu
Frans J Th
FJ
Wackers
Deborah A
DA
Chyun
Lawrence H
LH
Young
Gary V
GV
Heller
Ami E
AE
Iskandrian
Janice A
JA
Davey
Eugene J
EJ
Barrett
Raymond
R
Taillefer
Steven D
SD
Wittlin
Neil
N
Filipchuk
Robert E
RE
Ratner
Silvio E
SE
Inzucchi
D000241:Adenosine; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D044469:Racial Groups; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine