title: Silent myocardial ischemia in middle-aged asymptomatic patients with type 2 diabetes in Turkish population.
abstract: The authors investigated silent myocardial ischemia in unselected consecutive middle-aged asymptomatic patients with type 2 diabetes without any evidence of coronary heart disease documented by treadmill exercise test. Ninety asymptomatic patients with type 2 diabetes (48 men; mean age: 49 +/-6 years) were included in the study. Mean duration of diabetes in the study group was 4 +/-4.2 years (range 1 to 21 years); 38% of the study population, diabetes duration was only 1 year). All patients were subjected to treadmill exercise test with Bruce protocol. A positive test was noted in 4 of 90 (4%) study patients. Two male patients (4%) and 2 (4%) women patients developed exercise-induced ST-segment depression, but none had concomitant chest pain. Diabetics with silent myocardial ischemia were older (55 +/-3 years vs 49 +/-6 years, p = 0.04) than those without silent myocardial ischemia. Also, diabetics with silent myocardial ischemia had higher fibrinogen level (372 +/-51 vs 307 +/-71 mg/dL, p = 0.04) than diabetics without silent myocardial ischemia. In treadmill exercise test, diabetics with silent myocardial ischemia had lower total exercise time and peak workload (375 +/-30 vs 474 +/-115 seconds, p = 0.04; 7.3 +/-0.5 vs 8.9 +/-1.9, p = 0.04, respectively) than without silent myocardial ischemia. Insulin resistance is associated with a variety of atherosclerosis risk factors. Exercise test findings show increased cardiac sympathetic activity and parasympathetic withdrawal in increased insulin resistance.
authors.affiliation: Department of Endocrinology and Metabolism, Trakya University, Edime, Turkey. habeug@yahoo.com
authors.forename: Betul
authors.initials: B
authors.lastname: Ugur-Altun
authors.forename: Armagan
authors.initials: A
authors.lastname: Altun
authors.forename: Sibel
authors.initials: S
authors.lastname: Guldiken
authors.forename: Ersan
authors.initials: E
authors.lastname: Tatli
authors.forename: Mujdat
authors.initials: M
authors.lastname: Kara
authors.forename: Armagan
authors.initials: A
authors.lastname: Tugrul
mesh_terms: D000328:Adult; D000367:Age Factors; D017023:Coronary Angiography; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006321:Heart / Q000294:innervation; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D011446:Prospective Studies; D013564:Sympathetic Nervous System / Q000503:physiopathology; D014421:Turkey / Q000453:epidemiology
chemical_list: D005340:Fibrinogen