Early detection of coronary artery disease in asymptomatic type 2 diabetes mellitus patients


  • Narayan Chandra Sarkar Department of Cardiology, Shri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
  • Siddhant Jain Department of Cardiology, Shri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
  • Piyabi Sarkar PG Resident, IPGME & R, Kolkata, West Bengal, India
  • Mahendra Tilkar Department of Medicine, Shri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
  • Nitin Modi Department of Cardiology, Shri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India


Type 2 diabetes mellitus, Risk factor, TMT, CAG, Early detection of CAD, Revascularization


Background: Type II Diabetes Mellitus (DM) is a major risk factor for Coronary Artery Disease (CAD). Patients remain mostly asymptomatic and thus diagnosed at an advance stage of the disease. Our aim of study was to detect the CAD at an early stage in asymptomatic diabetic patients.

Methods: 136 asymptomatic type II diabetes mellitus patients were enrolled prospectively for treadmill test (TMT) and subsequent coronary angiography (CAG) was performed on 96 (70.87%) TMT positive patients. Diabetic status, clinical parameters including risk factors, TMT and angiographic findings were analyzed.

Results: The patients were divided into two groups, high rich group A (risk factor >2) and low risk group B (risk factor >1). 34 patients of group A (36.95%) were CAD positive out of 92 patients of high risk group and 4 patients group B (9.09%) out of 44 patients of low rich group. Duration of diabetes mellitus and multiple risk factors were correlated with coronary artery disease (CAD) as well as multiple coronary artery involvement.

Conclusions: A routine TMT of all long standing asymptomatic type 2 diabetic patients (>10 years) with family history of CAD and subsequent  CAG should be done on all TMT positive patients for early detection of CAD to take early appropriate revascularization measure.


Kannel WB, McGee DL. Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study. Diabetes Care. 1979;2:120-6.

American Diabetes Association. Consensus development conference on the diagnosis of coronary heart disease in people with diabetes. Diabetes Care. 1998;21:1551-9.

Lim S, Choi SH, Choi EK, Chang SA, Ku YH, Chun EJ, et al. Comprehensive evaluation of coronary arteries by multidetector-row cardiac computed tomography according to the glucose level of asymptomatic individuals. Atherosclerosis. 2009 Jul;205(1):156-62.

Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, et al. ACC/AHA guideline for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 1997;30:260-311.

Bonow Ro, Bohannon N, Hazzard W. Risk stratification in coronary artery disease and special populations. Am J Med. 1996;101:4A17S-22S.

Haffener SM, Lehto S, Ronnemaa T, Pyorala L, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetics subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229-34.

Wachkers FJ, Chyun DA, Young LH, Heller GV, Iskandrian AE, Davey JA, et al. Resolution of asymptomatic myocardial ischemia in patients with type 2 diabetes in the detection of ischemia in asymptomatic diabetics (DIAD) study. Diabetes Care. 2007;30:2892-8.

Brun E, Nelson RG, Bennett PH, Imperatore G, Zoppini G, Verlato G, et al. Diabetes duration and cause specific morality in the Verona Diabetes Study. Diabetes Care. 2000;23:1119-23.

Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-years cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16:434-44.

Chiariello M, Indolfi C. Silent myocardial ischemia in patients with diabetes mellitus. Circulation. 1996;93:2089-91.

Haffner SM. Coronary heart disease in patients with diabetes. N Engl J Med. 2000;342:1040-2.

Janand-Delenne B, Savin B, Habib G, Bory M, Vague P, Lassmannvague V. Silent myocardial ischemia in patients with diabetes: who to screen. Diabetes Care. 1999;22:1396-400.

Koistinen MJ. Prevalence of asymptomatic myocardial ischemia in diabetic subjects. BMJ. 1990;301:92-5.

Milan study on Atherosclerosis and Diabetes Group. Prevalence of unrecognized silent myocardial ischemia and its association with atherosclerotic risk factors in noninsulin-dependent diabetes mellitus. Am J Cardiol. 1997;79:134-9.

Langer A, Freeman MR, Josse RG, Steiner G, Armstrong PW. Detection of silent myocardial ischemia in diabetes mellitus. Am J Cardiol. 1991;67:1073-8.

Foster MC, Hwang SJ, Larson MG, Parikh NI, Meigs JB, Vasan RS, et al. Cross-classification of microalbuminuria and reduced glomerular filtration rate: associations between cardiovascular disease risk factors and clinical outcomes. Arch Intern Med. 2007;167:1386-92.

Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129-40.

D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: Framinham Heart study. Circulation. 2008;117:743.

Libby P, Ridker PM, Hansson GK, Leducq Transatlantic Network on Atherothrombosis. Information in atherosclerosis: from pathology to practice. J Am Coll Cardiol. 2009;54:2129-38.






Original Research Articles