European Journal of Cardiovascular Medicine

Background: The present study was designed to develop criteria for screening patients with type 2 diabetes mellitus (T2DM) for asymptomatic coronary artery disease (CAD). Diabetic patients with asymptomatic CAD have a higher cardiac mortality risk than those with symptomatic CAD. An important aspect of cardiovascular disease in diabetes is the prevalence of asymptomatic CAD. Diabetics have increased incidence of silent ischemia and myocardial infarction that has been attributed to prolonged anginal perception threshold due to autonomic neuropathy involving sympathetic fibers innervating the heart.   Materials and methods: Seventy adult subjects with diagnosed T2DM were recruited from the Diabetes Mellitus Outpatient Clinic. The inclusion criteria were: type T2DM, according to ADA and IDF criteria, and age >d18 years. The exclusion criteria were: history of myocardial infraction, stroke, coronary revascularization or cardiac bypass, active liver disease, any chronic renal disease, any autoimmune disease, HIV infection, malignancy, primary neurologic disorders (previous spinal injury, a history of lumbar or cervical discopathy, carpal tunnel syndrome, alcoholism, inherited neuropathy), vitamin B9 or B12 deficiency, concomitant use of glucocorticoid, isoniazid or metronidazole. Result: In our Study we performed Exercise Treadmill Test on participants. We found that 25 (35.7 %) of the Total participants had Positive Treadmill Test results which consist of 15 Male participants and 10 Female participants while remaining 45 (64.3%) of the study group had negative Treadmill Test results which included 30 Male participants and 15 Female participants.   During Treadmill test on Diabetic study participants, we found positive results in 25 (35.7%) of the study participants suggestive of coronary artery disease. Hence in our study we found 35.7% prevalence of Asymptomatic Coronary Artery disease based on TMT results. In our Study we also assessed study participants for presence of Autonomic Neuropathy. We found that 20 (28.6%) of study participants had Autonomic Neuropathy and 50 (71.4%) study participants did not have Autonomic Neuropathy. Conclusion: We found the main differences between the asymptomatic patients with significant coronary stenosis and those with a negative ETT were the duration of diabetes and age. It is well known that age is a strong predictor of CAD, however, duration of diabetes is not included among CAD predictors in the ADA recommendations. Further studies are needed to evaluate the effectiveness of routine screening for asymptomatic CAD in this patient subgroup.