title: Detection of silent myocardial ischaemia in asymptomatic diabetic patients during treadmill exercise testing.
abstract: BACKGROUND
  Diabetic patients have an increased prevalence of atherosclerosis and coronary artery disease. They may also experience higher morbidity and mortality after acute coronary syndrome compared with non-diabetic subjects.
  
  
  OBJECTIVE
  The objective of this study was to determine the presence of silent myocardial ischaemia by treadmill test in asymptomatic diabetic patients and to compare it with age- and sex-matched subjects without diabetes mellitus.
  
  
  METHODS
  The study design was cross-sectional and the setting was a tertiary care centre. Fifty (42 males, 8 females) asymptomatic patients with diabetes in the age group of 30-70 years were included in the study group and 30 (24 males, 6 females) non-diabetic subjects of comparable age, sex and physical activity were the control group. They were assessed for the presence of silent ischaemia by a standard treadmill test using the Bruce protocol.
  
  
  RESULTS
  Twenty-five of 50 diabetic patients showed a positive response to the exercise stress test, while 7 of 30 controls showed stress test positivity (p < 0.05). The stress test positivity showed a female predilection among diabetic patients (50% in diabetic patients and 16.67% in controls; p < 0.05). Diabetic patients with a positive stress test showed higher prevalence of hypertension (36%) and dyslipidaemia (84%) compared with diabetic patients with a negative stress test (12% and 28%, respectively) [p < 0.001]. The controls showed a better exercise capacity compared with diabetic patients; diabetic patients with a negative stress test had better exercise capacity than those with a positive stress test.
  
  
  CONCLUSIONS
  The treadmill test is a useful, specific, cost-effective, non-invasive tool for detection of silent myocardial ischaemia in asymptomatic diabetic patients.
authors.affiliation: Department of Medicine, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, India. lovleen_dr@yahoo.co.in
authors.forename: Lovleen C
authors.initials: LC
authors.lastname: Bhatia
authors.forename: Rikki
authors.initials: R
authors.lastname: Singal
authors.forename: Parul
authors.initials: P
authors.lastname: Jain
authors.forename: Neha
authors.initials: N
authors.lastname: Mishra
authors.forename: Varoon
authors.initials: V
authors.lastname: Mehra
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005080:Exercise Test / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D012680:Sensitivity and Specificity