|
|
||||||||||
|
J Am Coll Cardiol, 2002; 40:56-61 © 2002 by the American College of Cardiology Foundation |

* Department of Medicine, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom
Manuscript received September 11, 2001; revised manuscript received March 28, 2002, accepted April 5, 2002.
* Reprint requests and correspondence: Dr. Martin K. Rutter, Cardiology Department, The Lahey Clinic, 41 Mall Road, Burlington, Massachusetts 01805, USA.
Martin.K.Rutter{at}btinternet.com
OBJECTIVES: The aim of this study was to investigate the relationships between future coronary heart disease (CHD) events and baseline silent myocardial ischemia (SMI) and microalbuminuria (MA) in subjects with type 2 diabetes (T2D) free from known CHD.
BACKGROUND: Coronary heart disease is often asymptomatic in subjects with diabetes. There is limited information on the prognostic value of SMI and MA in this group.
METHODS: Eighty-six patients with T2D and no history of CHD were studied (43 with MA individually matched with 43 normoalbuminuric patients; mean [SD] age 62 [±7] years, 62 men). Metabolic assessment, three timed overnight urine collections for albumin excretion rate, a treadmill exercise test and ankle brachial index (ABI) were performed at baseline. Patients were followed for 2.8 years.
RESULTS: Forty-five (52%) patients had SMI during treadmill testing. At review, there had been 23 coronary (CHD) events in 15 patients. Univariate Cox regression analysis showed that CHD events were significantly related to baseline ABI (p = 0.014), SMI (p = 0.020), MA (p = 0.046), 10-year Framingham CHD risk >30% (p = 0.035) and fibrinogen (p = 0.026). In multivariate analysis, SMI was the strongest independent predictor of CHD events (p = 0.008); risk ratio (95% confidence interval) for SMI: 21 (2 to 204). In the prediction of CHD events, SMI showed higher sensitivity and positive predictive value than MA or Framingham calculated CHD risk.
CONCLUSIONS: The presence of baseline SMI and MA are associated with future CHD events in asymptomatic patients with T2D and may be of practical use in risk stratification.
| ||||||||||||||||||||||||
This article has been cited by other articles:
![]() |
B. Ugur-Altun, A. Altun, S. Guldiken, E. Tatli, M. Kara, and A. Tugrul Silent Myocardial Ischemia in Middle-Aged Asymptomatic Patients With Type 2 Diabetes in Turkish Population Angiology, November 1, 2007; 58(5): 535 - 542. [Abstract] [PDF] |
||||
![]() |
A. Struthers and C. Lang The potential to improve primary prevention in the future by using BNP/N-BNP as an indicator of silent 'pancardiac' target organ damage: BNP/N-BNP could become for the heart what microalbuminuria is for the kidney Eur. Heart J., July 2, 2007; 28(14): 1678 - 1682. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. M. Mostaza, C. Suarez, L. Manzano, M. Cairols, F. Garcia-Iglesias, J. Sanchez-Alvarez, J. Ampuero, D. Godoy, A. Rodriguez-Samaniego, M. A. Sanchez-Zamorano, et al. Relationship between Ankle-Brachial Index and Chronic Kidney Disease in Hypertensive Patients with No Known Cardiovascular Disease J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S201 - S205. [Abstract] [Full Text] [PDF] |
||||
![]() |
B S Rana, J I Davies, M M Band, S D Pringle, A Morris, and A D Struthers B-type natriuretic peptide can detect silent myocardial ischaemia in asymptomatic type 2 diabetes Heart, July 1, 2006; 92(7): 916 - 920. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. Valensi, J. Paries, V. Brulport-Cerisier, F. Torremocha, R.-N. Sachs, G. Vanzetto, E. Cosson, B. Lormeau, J.-R. Attali, R. Marechaud, et al. Predictive Value of Silent Myocardial Ischemia for Cardiac Events in Diabetic Patients: Influence of age in a French multicenter study Diabetes Care, November 1, 2005; 28(11): 2722 - 2727. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. D. Beishuizen, J. W. Jukema, J. T. Tamsma, M. A. van de Ree, J. C. M. van der Vijver, H. Putter, A. C. Maan, A. E. Meinders, and M. V. Huisman No Effect of Statin Therapy on Silent Myocardial Ischemia in Patients With Type 2 Diabetes Without Manifest Cardiovascular Disease Diabetes Care, July 1, 2005; 28(7): 1675 - 1679. [Abstract] [Full Text] [PDF] |
||||
![]() |
J.-C. Fruchart, M. C. Nierman, E. S. G. Stroes, J. J. P. Kastelein, and P. Duriez New Risk Factors for Atherosclerosis and Patient Risk Assessment Circulation, June 15, 2004; 109(23_suppl_1): III-15 - III-19. [Abstract] [Full Text] |
||||
![]() |
A. A.M. Zandbergen, M. G.A. Baggen, and R. J.Th. Ouwendijk Losartan for Microalbuminuria in Normotensive Type 2 Diabetes Mellitus Ann Intern Med, April 20, 2004; 140(8): 668 - 669. [Full Text] [PDF] |
||||
![]() |
M. J Zellweger, R. Hachamovitch, X. Kang, S. W Hayes, J. D Friedman, G. Germano, M. E Pfisterer, and D. S Berman Prognostic relevance of symptoms versus objective evidence of coronary artery disease in diabetic patients Eur. Heart J., April 1, 2004; 25(7): 543 - 550. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Fowler-Brown, M. Pignone, M. Pletcher, J. A. Tice, S. F. Sutton, and K. N. Lohr Exercise Tolerance Testing To Screen for Coronary Heart Disease: A Systematic Review for the Technical Support for the U.S. Preventive Services Task Force Ann Intern Med, March 1, 2004; (2004) 6052004040601. [Abstract] [Full Text] |
||||
![]() |
P. F. Cohn, K. M. Fox, and C. Daly Silent Myocardial Ischemia Circulation, September 9, 2003; 108(10): 1263 - 1277. [Full Text] [PDF] |
||||
![]() |
A. A.M. Zandbergen, M. G.A. Baggen, S. W.J. Lamberts, A. H. Bootsma, D. de Zeeuw, and R. J.Th. Ouwendijk Effect of Losartan on Microalbuminuria in Normotensive Patients with Type 2 Diabetes Mellitus: A Randomized Clinical Trial Ann Intern Med, July 15, 2003; 139(2): 90 - 96. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Cosson, M. Guimfack, J. Paries, F. Paycha, J.-R. Attali, and P. Valensi Prognosis for Coronary Stenoses in Patients With Diabetes and Silent Myocardial Ischemia Diabetes Care, April 1, 2003; 26(4): 1313 - 1314. [Full Text] [PDF] |
||||
![]() |
A. Fowler-Brown, M. Pignone, M. Pletcher, J. A. Tice, S. F. Sutton, and K. N. Lohr Exercise Tolerance Testing To Screen for Coronary Heart Disease: A Systematic Review for the Technical Support for the U.S. Preventive Services Task Force Ann Intern Med, April 6, 2004; 140(7): W-9 - W-24. [Abstract] [Full Text] [PDF] |
||||
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |