Hasan Akbar Khan, Muhammad Shuaib, Saman Sabir, Ayesha Aimen, Murtaza Bukhari, Muhammad Irfan


Background: Silent myocardial ischemia (SMI) is more prevalent in type 2 diabetes mellitus (T2DM) patients, resulting in worse cardiovascular outcomes in the future. Therefore, it’s early and prompt diagnosis is the need of the hour. It can be identified by traditional cardiac stress testing such as exercise tolerance test. Presence of SMI can also be predicted by microalbuminuria as it can significantly forecast any future cardiovascular event. The objective of this study was to find out the frequency of SMI in T2DM patients with microalbuminuria.

Materials & Methods: A cross-sectional survey was carried out at the Diabetes Research Centre Outpatients Clinic, Nishtar Hospital, Multan, 01/01/2020 to 30/06/2020. After taking informed consent, patients having T2DM and microalbuminuria were included. Every participant had to undergo exercise tolerance test (ETT). Patients were regarded as having SMI if they fulfilled Bruce protocol and had myocardial ischemia on stress ETT. All gathered data was analyzed using SPSS version 24. Mean and standard deviation was measured for age and duration of DM. Frequency and percentage was measured for gender and presence or absence of SMI as confirmed by ETT.

Results: This study comprised of a total 81 patients. Mean age of patients was 49.72±6.75 years, with range of 30. Male patients were 49(60.5%) whereas 32(39.5%) were female. Mean duration of T2DM was 12.52±4.71 years. SMI was present in 34 (41.9%) T2DM patients with microalbuminuria, as confirmed by ETT. Among the positive cases, majority belonged to 51-60 years age group (50.0%) and most of them were males 20 (58.8%). The majority of patients aged more than 60 years had SMI (85.7%), detected by ETT.

Conclusion: Frequency of SMI in the current study (41.9%) is startling and direct us for earlier diagnosis and management of T2DM and microalbuminuria to prevent any cardiovascular event. Screening with ETT should be done for SMI in every diabetic patient with microalbuminuria.


Type 2 Diabetes Mellitus; Microalbuminuria; Silent Myocardial Ischemia; Exercise tolerance test.

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Yu J, Lee S-H, Kim MK. Recent Updates to Clinical Practice Guidelines for Diabetes Mellitus. Endocrin Metab Clin. 2022;37(1):26-37.

Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pr. 2022;183:109119.

Chauhan S, Ghosh M, Agrawal PK, Singh MP, Alam W. Prevalence of silent myocardial ischemia in type 2 diabetes mellitus with microalbuminuria. Int J Adv Med. 2017;4(1):40.

Aschner P, Karuranga S, James S, Simmons D, Basit A, Shaw JE, et al. The International Diabetes Federation's guide for diabetes epidemiological studies. Diabetes Res Clin Pr. 2021;172.

Cui J, Liu Y, Li Y, Xu F, Liu YJFicm. Type 2 diabetes and myocardial infarction: recent clinical evidence and perspective. Front Cardiovasc Med. 2021:64.

Prasad D, Kabir Z, Devi KR, Peter PS, Das B. Prevalence and RIsk factors for Silent Myocardial ischemia (PRISM): A clinico observational study in patients of type 2 diabetes. Indian heart j. 2019;71(5):400-5.

Chain S, Saran MR, Kasana RK, Agarwal VK. Association of Microalbuminuria with IHD in Asymptomatic Type-2 Diabetes Mellitus Patients. J Med Sci Clin Res. 2019;7(9):370-7.

Zabeen S, Hoque MM, Rahman MR. Silent Myocardial Ischemia (SMI) and its Association with Microalbuminuria in Type 2 Diabetes Mellitus (DM). 2012;5(1):42-5.

Nonterah EA, Boateng D, Crowther NJ, Klipstein-Grobusch K, Oduro AR, Agongo G, et al. Carotid Atherosclerosis, Microalbuminuria, and Estimated 10-Year Atherosclerotic Cardiovascular Disease Risk in Sub-Saharan Africa. Jama-J Am Med Assoc. 2022;5(4):e227559-e.

Ahmad T, Ulhaq I, Mawani M, Islam NJPjoms. Microalbuminuria in Type-2 Diabetes Mellitus; the tip of iceberg of diabetic complications. Pak J Med Sci. 2017;33(3):519-23.

Hussain Q, Bukhari MH, Afzaal F, Fatima W. Microalbuminuria (Moderate Albumin Excretion) and its relationship with Silent myocardial ischemia in treatment naïve type II diabetic patients. Pak J Med Sci. 2020;36(3):496-500.

Hussein AZF, Strak SK. Silent myocardial ischemia and microalbuminuria in asymptomatic Type-2 Diabetic patients. Pak J Med Sci. 2006;22(2):116-22.

Vilcant V, Zeltser R. Treadmill Stress Testing. StatPearls [Internet]: StatPearls Publishing; 2022.

Toniolo A, Cassani G, Puggioni A, Rossi A, Colombo A, Onodera T, et al. The diabetes pandemic and associated infections: suggestions for clinical microbiology. Rev Med Microbiol. 2019;30(1):1-17.

Narres M, Kvitkina T, Claessen H, Ubach E, Wolff G, Metzendorf M-I, et al. Incidence of myocardial infarction in people with diabetes compared to those without diabetes: a systematic review protocol. Syst Rev. 2022;11(1):1-5.

Daryabor G, Atashzar MR, Kabelitz D, Meri S, Kalantar KJFii. The effects of type 2 diabetes mellitus on organ metabolism and the immune system. Front Immunol. 2020;11:1582.

Stehouwer CD, Smulders YMJJotASoN. Microalbuminuria and risk for cardiovascular disease: analysis of potential mechanisms. J Am Society Nephrol. 2006;17(8):2106-11.

Márquez DF, Ruiz-Hurtado G, Segura J, Ruilope L. Microalbuminuria and cardiorenal risk: old and new evidence in different populations. F1000Research. 2019;8:1659.

Hudspeth B, PharmD C. The burden of cardiovascular disease in patients with diabetes. Am J Manag Care. 2018;24(13 Suppl):S268-S72.

Ejaza M, Tariqa Z, Sabirb A, Kalimullaha CM, Sadiqa Z. Frequency of silent myocardial ischemia in patients with diabetic nephropathy J Cardiovasc Dis. 2018;14(4):104-7.

Khan I, Hasan M, Hasan J, Dhillon AI, Khan M, Kaneez M. Gauging the Positive Predictive Value of Exercise Tolerance Test Using Angiographic Evaluation: A Cross-Sectional Analysis From a Developing Country. Cureus. 2020;12(12):e12173.

Rutter MK, Wahid ST, McComb JM, Marshall SM. Significance of silent ischemia andmicroalbuminuria in predicting coronaryevents in asymptomatic patients with type 2 diabetes. J Am Coll Cardiol. 2002;40(1):56-61.

Handargal NH, Shetty SJ. Prevalence of asymptomatic silent myocardial ischemia among type 2 diabetes mellitus patients in Bangalore-A hospital-based cross-sectional study. J Pract Cardiovasc Sci. 2021;7(3):207-11.

Russo GT, Corigliano G, Arturi F, Cavallo MG, Bette C, Mannucci E. CAPTURE: A cross-sectional study on the prevalence of cardiovascular disease in adults with type 2 diabetes in Italy. Nutr Metab Cardiovas. 2022;32(5):1195-201.

Emami T, Naeimei Z, Salehifard A, Azizmohammadi Z, Iranpour D, Kalantarhormozi M, et al. Significance of microalbuminuria in predicting silent myocardial ischemia in patients with type 2 diabetes using myocardial perfusion imaging. Mol Imaging Radionucl Ther. 2019;28(2):62-8.

Hafsa F, Zaman S, Mahmood AU. Frequency of Asymptomatic Myocardial Ischemia in Type 2 Diabetic Patients with Microalbuminuria. PJMHS. 2020;14(1):567-70.



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