Summary
BackgroundScreening for silent myocardial ischaemia (SMI) is a controversial strategy undergoing intensive risk factor therapy.Aims
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.
Conclusion
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.
