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Resolution of Asymptomatic Myocardial Ischemia in Patients With Type 2 Diabetes in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Study

¹ Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
² Yale University School of Nursing, New Haven, Connecticut
³ Hartford Hospital, Hartford, Connecticut
⁴ University of Alabama, Birmingham, Alabama
⁵ University of Virginia, Charlottesville, Virginia
⁶ University of Montreal, Montreal, Quebec, Canada
⁷ University of Rochester, Rochester, New York
⁸ Cardiology Consultants, Calgary, Alberta, Canada
⁹ Medstar Research Institute, Washington, DC

Address correspondence and reprint requests to Frans J.Th. Wackers, MD, Yale University School of Medicine, Section of Cardiovascular Medicine, 333 Cedar St. Fitkin-3, New Haven, CT 06520. E-mail: frans.wackers{at}yale.edu

OBJECTIVE—The purpose of this study was to assess whether the prevalence of inducible myocardial ischemia increases over time in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS—Participants enrolled in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study underwent repeat adenosine-stress myocardial perfusion imaging 3 years after initial evaluation. Patients with intervening cardiac events or revascularization and those who were unable or unwilling to repeat stress imaging were excluded.

RESULTS—Of the initial 522 DIAD patients, 358 had repeat stress imaging (DIAD-2), of whom 71 (20%) had ischemia at enrollment (DIAD-1). Of 287 patients with normal DIAD-1 studies, 259 (90%) remained normal in DIAD-2, whereas 28 (10%) developed new ischemia in DIAD-2. Of the 71 patients with abnormal DIAD-1 studies, 56 (79%) demonstrated resolution of ischemia, whereas 15 (21%) remained abnormal. During this 3-year interval, medical treatment was intensified, with more patients using statins, aspirin, and ACE inhibitors than at baseline. Patients with resolution of ischemia had significantly greater increases in these medications than patients who developed new ischemia (P = 0.04).

CONCLUSIONS—Thus, the majority of asymptomatic patients with type 2 diabetes demonstrated resolution of ischemia upon repeat stress imaging after 3 years. This resolution was associated with more intensive treatment of cardiovascular risk factors.

Abbreviations: CAD, coronary artery disease • DIAD, Detection of Ischemia in Asymptomatic Diabetics • ECG, electrocardiogram • SPECT, single photon emission computerized tomography

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