Authors: T M E Davis P Fortun J Mulder W A Davis D G Bruce
Publish Date: 2004/03/01
Volume: 47, Issue: 3, Pages: 395-399
Abstract
We analysed data from 1269 patients with Type 2 diabetes mellitus from a communitybased observational study of diabetes care control and complications Silent myocardial infarction was defined as Q waves Minnesota codes 11 12 on a baseline electrocardiogram in the absence of a history or symptoms of CHDSilent myocardial infarction was present in 39 of patients or 44 of all Qwave myocardial infarctions The patients were subdivided into those with i no clinical or Qwave evidence of myocardial infarction Group 1 ii silent myocardial infarction Group 2 iii selfreported CHD but no Q waves Group 3 and iv selfreported CHD and Q waves Group 4 Compared to Groups 3 and 4 Group 2 patients were more likely to be women less likely to have smoked and had higher serum HDLcholesterol concentrations and higher blood pressure Over an average of seven years and after adjusting for other independent predictors of death allcause and CHD mortality were similar in Groups 1 and 2 and greater twofold for allcause and fourfold for CHD mortality in Groups 3 and 4In crosssectional studies in the general population 15 to 40 of patients with ECG evidence of past myocardial infarction MI do not give a history of typical cardiac symptoms 1 2 3 Mortality rates in patients with such “silent” MIs have been reported as higher than similar to or lower than those in patients with known MI 1 2 3 Although their numbers are relatively small and clinical details are often incomplete diabetic patients included in populationbased studies do not have an increased propensity to silent MI 4 Thus although various noninvasive and invasive tests including coronary angiography have been recommended in the assessment of diabetic patients at high risk of silent ischaemia even when the resting ECG is normal 5 there are no epidemiological data justifying such an approach We therefore analysed data from a large wellcharacterised communitybased cohort of patients to assess the prevalence risk factors and prognosis of silent MI in patients with Type 2 diabetes
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