Intensive cardiovascular risk factors therapy and prevalence of silent myocardial ischaemia in patients with type 2 diabetes.
BACKGROUND
Screening for silent myocardial ischaemia (SMI) is a controversial strategy undergoing intensive risk factor therapy.


OBJECTIVE
To assess the prevalence of SMI and coronary artery disease (CAD) in asymptomatic type 2 diabetic patients at high cardiovascular risk (two additional risk factors or more) and undergoing long-term intensive risk factor therapy and tight glycaemic control.


METHODS
SMI screening, using isotopic or echographic stress tests, was carried out in 122 asymptomatic type 2 diabetic patients at high cardiovascular risk and undergoing long-term intensive risk factor therapy. Coronary angiography was proposed if SMI was detected. Long-term follow-up data on death, myocardial infarction and revascularization were obtained by telephone call or clinical review.


RESULTS
The mean age was 65+/-6 years and 74% of patients were men. The mean duration of diabetes was 15+/-9 years. The mean number of additional risk factors was 2.9, 32% of patients had microalbuminuria and 12% had peripheral arterial disease. SMI was detected in 20 (16%) patients. Seven (6%) patients had significant CAD treated successfully by angioplasty (n=6) or bypass surgery (n=1). The positive predictive value of the non-invasive screening test for the diagnosis of significant CAD (stenosis>50%) was 39%. The event rate was very low (1.6%) at 2-year follow-up.


CONCLUSIONS
Long-term intensive risk factor therapy in high-risk patients with type 2 diabetes is associated with low prevalence of SMI and detected CAD. Optimal medical therapy and revascularization of significant CAD are associated with a low cardiovascular event rate at two years.
Barthelemy
Olivier
O
Département de cardiologie médicale, institut de cardiologie, groupe hospitalo-universitaire Pitié-Salpêtrière, 47 et 83, boulevard de l'Hôpital, 75651 , Paris cedex 13, France. Olivier.barthelemy@psl.aphp.fr
Jacqueminet
Sophie
S
Rouzet
Francois
F
Isnard
Richard
R
Bouzamondo
Anissa
A
Le Guludec
Dominique
D
Grimaldi
André
A
Metzger
Jean-Philippe
JP
Le Feuvre
Claude
C
D000368:Aged; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D048909:Diabetes Complications / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome