Prevalence of Silent Ischemia in Diabetic Patients with Coronary Artery Disease

Background: Silent myocardial ischemia, defined as objective evidence of myocardial ischemia without anginal symptoms, is commonly observed in patients with diabetes mellitus due to autonomic neuropathy and vascular dysfunction. Objective: To determine the prevalence of silent myocardial ischemia in diabetic patients with angiographically confirmed coronary artery disease and to assess its association with clinical and metabolic risk factors. Methods: This cross-sectional observational study was conducted at Social Security Teaching Hospital Lahore from August 2024 to January 2025. A total of 205 patients were added to the study. Data were collected through a detailed clinical assessment of patients, including history, physical examination, and evaluation of cardiovascular risk factors (hypertension, dyslipidemia, smoking status, family history of CAD, etc.). Glycemic control was assessed using fasting plasma glucose and HbA1c levels. Results: Silent ischemia was detected in 84 patients, indicating a prevalence of 41.0%. The condition was more prevalent among patients with HbA1c ≥8.0% (47.2%) compared to those with HbA1c <8.0% (33.7%), although the association was not statistically significant (p = 0.4335). A higher prevalence was observed in patients with longer duration of diabetes (>10 years: 49.4%) and those with diabetic neuropathy (54.3%). Myocardial perfusion imaging yielded a higher detection rate (50.7%) compared to ETT (35.6%). Silent ischemia was significantly more common in patients with multiple cardiovascular risk factors (≥3 risk factors: 51.7%). Conclusion: It is concluded that silent myocardial ischemia is highly prevalent among diabetic patients with CAD, particularly those with poor glycemic control, long-standing diabetes, neuropathy, and multiple risk factors.