<b>Correlation Between Peripheral Arterial Stiffness and Silent Myocardial Ischemia in Diabetic Patients</b>

Background: Type 2 diabetes mellitus is associated with accelerated vascular dysfunction and clinically silent myocardial ischaemia. Peripheral arterial stiffness may reflect systemic vascular injury associated with occult myocardial ischaemia. Objective: To evaluate the association between peripheral arterial stiffness and silent myocardial ischaemia among patients with type 2 diabetes mellitus. Methods: This hospital-based cross-sectional imaging study included 150 patients with T2DM at Aziz Fatima Medical & Dental College Teaching Hospital, Gujranwala, Pakistan. Peripheral arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI). Silent myocardial ischaemia was assessed using resting electrocardiography and clinically indicated stress myocardial perfusion imaging. Group comparisons used continuous and categorical statistical tests as appropriate. Results: Silent myocardial ischaemia was identified in 46 participants (30.7%). Mean baPWV was higher in participants with SMI than in those without SMI (1896 ± 245 vs 1568 ± 210 cm/s), with a mean difference of 328 cm/s (95% CI 245.2–410.8; p<0.001; Hedges’ g=1.48). The SMI group also had lower ABI (0.96 ± 0.08 vs 1.02 ± 0.07; p=0.002), higher HbA1c (8.6 ± 1.5% vs 7.8 ± 1.3%; p=0.003), longer diabetes duration (12.4 ± 5.6 vs 9.2 ± 4.6 years; p=0.001), and higher systolic blood pressure (143 ± 18 vs 136 ± 16 mmHg; p=0.021). Conclusion: Greater peripheral arterial stiffness was associated with silent myocardial ischaemia in patients with T2DM, with baPWV demonstrating the largest observed between-group difference. These findings support further evaluation of arterial stiffness as a cardiovascular risk marker but do not establish independent predictive or diagnostic performance