Prevalence of silent myocardial ischemia in type 2 diabetes mellitus with microalbuminuria

Sonu Chauhan, Mrinmay Ghosh, Pramod Kumar Agrawal, Mrityunjay Pratap Singh, Wasim Alam


Background: The study was designed to assess the prevalence of silent myocardial ischemia (SMI) in asymptomatic patients of type 2 diabetes mellitus (T2DM) with and without microalbuminuria, by the exercise electrocardiography and to assess the role of microalbuminuria as a marker for detecting silent coronary artery disease (CAD) and role of other conventional CAD risk factors in diabetic patients in development of SMI.

Methods: A total of 60 patients with type 2 diabetes mellitus who were dipstick negative for macroalbuminuria and had no history suggestive of CAD or ECG abnormality were taken. Out of 60 patients 30 patients were positive for microalbuminuria by Micral Test® II sticks and 30 were tested negative for microalbuminuria. Subsequently, they were divided into case and control groups.

Results: The risk of undetected CAD was increased in male Type 2 diabetics (p <0.05) and in the presence of Microalbuminuria (p <0.05). A positive correlation was found between exercise time and amount of work performed during treadmill test (TMT). A positive TMT with angiographically proven significant coronary stenosis is higher in male and in patients having microalbuminuria.

Conclusions: Patients with T2DM and microalbuminuria have significant association with SMI as proven by TMT and coronary angiography. Patient have SMI with severe disease might benefit from revascularization. Patients with less severe disesase may benefit from drug and lifestyle interventions.


Coronary artery disease, Diabetes mellitus, Microalbuminuria, Silent myocardial ischemia, Treadmill test

Full Text:



Kasper, Fauci, Hauser, Longo. Harrison’s principles of Internal Medicine. 19th edition McGraw Hill Education. New York. NY: 2015:2399.

Hovens MMC, Loar FA. Acetylsalicyclic acid (aspirin) for primary prevention of cardiovascular disease in type 2 diabetes (protocol). Cochrane Database Syst Rev. 2005;3:CD005446.

Diabetes in India- an epidemiological review. Current Controversies and Consensus in Diabetes Management. Available at Accessed on 12 July 2016.

Walker BR, Colledge NR. Davidson’s principles and practice of Medicine. Elsevier Health, UK, 22nd edition; 2014:800.

International Diabetes Federation - IDF Diabetes Atlas. Available at http:// /diabetesatlas /. Accessed on 17 August 2016.

Major RM. A history of medicine. Blackwell, Oxford; 1954:67.

Fries JF. Frailty, heart disease and strock. The compression of morbidity paradigm. American J Pre Med. 2015;29:164.

International Diabetes Federation. The Diabetes Atlas, 6th ed. Poster update; 2014.

Anjana RM, Pradeepa R, Deepa M. Prevalence of diabetes and prediabetes in rural and urban India. Phase 1 results of the Indian Council of Medical Research- India Diabetes (ICMR-INDIAB) study. Diabetologia. 2011;54(12):3022-7.

Unwin N, Whiting D, Guariguata L, Ghyoot G, Gan D. The IDF Diabetes atlas, 5th edition. Brussels, Belgium: International Diabetes Federation; 2011.

Emila BE, Vlad BV. Detection of silent ischemia in patients with type 2 diabetes, recent advances in the pathogenesis, prevention of type 2 diabetes and its complication, Prof. Mark Zimering (Ed.). 2011;978-953-307-597-6.

Zabeen S, Hoque M, Rahman R. Silent myocardial ischemia and its association with microalbuminuria in type 2 diabetes mellitus. BSMMU J. 2012;5(1):42-5.

Tabibiazar R, Edelman SV. Silent ischemia in people with diabetes: a condition that must be heard, clinical. Clinical Diabetes. 2003;21(1):5-9.

Boras J, Neva B, Antolena L. Silent ischemia and diabetes mellitus. Diabetologia Croatica. 2010;39(2):57-66.

Walker BR, Colledge NR. Davidson’s Principles and practice of medicine 22nd edition; 2014:583.

Stenhouwer CD. Endothelial dysfunction and pathogenesis of diabetic angiopathy. Cardivascular Res. 1997;34:5560-4.

American Diabetes Association. Standards of medical care in diabetes-2014. Diabetes Care. 2014;37(1):14-80.

Fletcher GF, Ades PA, Kligfield P. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128:873.

Zipes D, Libby P, Bonow R, Braunwald E. Braunwald’s Heart disease. 10th edition. Philadelphia: Elsevier Saunders; 2015:395.

Adler AI, Stevens RJ, Manley SE, Bilous RW, Carole A, Rury R. Development and progression of nephropathy in type 2 diabetes. Kidney International. 2003;63(1):225-32.

Gupta DK, Verma LK, Khosla PK. The prevalence of microalbuminuria in diabetes: a study from north India. Diabetes Res Clin Pract. 1991;12:125-8.

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

Milan study on atherosclerosis and diabetes (MiSAD) group. Prevalence of unrecognized silent myocardial ischemia and its association with atherosclerotic risk factors in non-insulin dependent diabetes mellitus. Am J Cardiol. 1997;79:134-9.

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

Naka M, Hiramatsu K, Aizawa T. Silent myocardial ischemia in patients with non-insulin dependent diabetes mellitus as judged by treadmill exercise testing and coronary angiography. Am Heart J. 1992;123:46-53.

Gianrossi R, Detrano R, Mulvihill D. Exercise-induced ST depression in the diagnosis of coronary artery disease: a meta-analysis. Circulation. 1989;80:87-98.

Gerstein HC, Mann JF, Yi Q. Albuminuria and risk of cardiovascular events, death and heart failure in diabetic and non-diabetic individuals. JAMA. 2001;286:421-6.