Intensive cardiovascular risk factors therapy and prevalence of silent myocardial ischaemia in patients with type 2 diabetes

Background. - Screening 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. Longterm 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 tow (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. (c) 2008 Elsevier Masson SAS. All rights reserved.