Silent coronary heart disease in patients with type 2 diabetes: Application of a screening approach in a follow-up study

Saula Vigili de Kreutzenberg, Anna Solini, Edoardo Vitolo, Alessandra Boi, Simonetta Bacci, Sara Cocozza, Rossella Nappo, Angela Rivellese, Angelo Avogaro, Marco Giorgio Baroni

Research output: Contribution to journalArticlepeer-review

Abstract

Aims The cost-effectiveness of screening for silent coronary heart disease (CHD) in type 2 diabetes (DM2) is still debated. Methods We applied a diagnostic algorithm for silent CHD detection, in a cohort of 102 asymptomatic DM2 subjects (57 ± 7 years), attending 5 Italian outpatient clinics, to verify its predictive value. The risk of silent CHD was calculated considering classical risk factors, and presence of microangiopathy/macroangiopathy. Patients were divided in 3 groups, i.e. group 1: normal ECG and low silent CHD risk; group 2: abnormal ECG, irrespective of silent CHD risk; group 3: high silent CHD risk, irrespective of ECG. To group 2 and 3, a functional test was recommended and performed in 78% of patients. Results Silent CHD prevalence was similar in group 2 and 3 (25 vs. 17% respectively; p = 0.495). However, evaluating the entire cohort, a significant higher prevalence of silent CHD was observed in subjects with abnormal vs. normal ECG (23 vs. 4%; P = 0.004), but not in subjects with high vs. low pre-test silent CHD risk (14 vs. 9%; p = 0.472). Conclusions An abnormal ECG was a strong, independent predictor of silent CHD (OR 8.9; CI 1.27–62.5; p = 0.028) in DM2. Therefore, a functional stress testing should be considered in DM2 patients with ECG abnormalities.

Original languageEnglish
Pages (from-to)952-957
Number of pages6
JournalJournal of Diabetes and its Complications
Volume31
Issue number6
DOIs
Publication statusPublished - Jun 1 2017

Keywords

  • CHD diagnosis
  • Diabetes complications
  • Electrocardiogram
  • Positive predictive value
  • Silent coronary heart disease ischemia
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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