One of the main causes of elevated cardiovascular morbidity and mortality in individuals with diabetes is silent myocardial ischemia (SMI), a disease that is commonly underdiagnosed. Chronic hyperglycemia, oxidative stress, endothelial dysfunction, and low-grade inflammation further predispose diabetics to SMI, while the lack of common symptoms like angina (especially in diabetics with altered pain perception due to autonomic neuropathy) makes ischemic episodes invisible.
However, because of its lack of symptoms and the limits of routine screening, it frequently goes unnoticed despite its grave effects. This illuminates the critical need for proactive risk stratification and focused diagnostic techniques. Thus, to improve early identification through targeted risk stratification and inform customized screening strategies to lower cardiovascular events in this high-risk group, Hafiz Abdul Manan and team carried out this study to ascertain the prevalence and important risk factors linked to SMI in diabetic adults.
From May 2020 to May 2021, Jinnah Hospital in Lahore hosted this cross-sectional research. Time and budget constraints led to the convenient sampling of 162 diabetic individuals aged ≥40 years, with ≥5 years of diabetes and no history of coronary artery disease. A review of the participants' medical histories, physical examinations, lab tests (lipid profile, HbA1c), and cardiac evaluations (resting ECG, exercise stress testing, and myocardial perfusion imaging) were all performed.
A total of 61 (37.65%) of the diabetic patients had SMI. A number of independent predictors of SMI were found using multivariate logistic regression analysis, including smoking, high blood pressure, dyslipidemia, diabetes that has been present for more than 10 years, and inadequate glycemic management.
Growing older was also strongly linked to a higher risk of SMI, with a noticeable increase in prevalence seen beyond the age of 55. In order to prevent negative cardiovascular outcomes, our findings emphasize the high prevalence of silent myocardial ischemia in diabetics and the significance of identifying critical indicators to assist early identification, focused screening, and risk-based treatment techniques.
Overall, this study finds a number of important characteristics, such as poor glycemic control, long-standing diabetes, hypertension (HTN), dyslipidemia, smoking, and advanced age, that contribute to the alarming prevalence of SMI in diabetic patients.
Source:
Abdul Manan, H., Chishti, H. R., & Hewlett, F. D. (2025). Prevalence and predictors of silent myocardial ischemia in diabetic patients. Cureus. https://doi.org/10.7759/cureus.82407
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