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Diabetes Care Publish Ahead of Print published online ahead of print August 6, 2007
DOI: 10.2337/dc07-1250
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Original Research

Resolution of Asymptomatic Myocardial Ischemia in Patients with Type 2 Diabetes Mellitus in the DIAD Study.

Frans J. Th Wackers, MD1, Deborah A. Chyun, PHD2, Lawrence H. Young, MD1, Gary V. Heller, MD3, Ami E. Iskandrian, MD4, Janice A. Davey, MSN1, Eugene J. Barrett, MD5, Raymond Taillefer, MD6, Steven D. Wittlin, MD7, Neil Filipchuk, MD8, Robert E. Ratner, MD9, Silvio E. Inzucchi, MD 10 and for the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Investigators

1 Yale University School of Medicine (Department of Internal Medicine, Section of Cardiovascular Medicine), New Haven, CT
2 Yale University School of Nursing, New Haven, CT
3 Hartford Hospital, Hartford, CT
4 University of Alabama, Birmingham, AL
5 University of Virginia, Charlottesville, VA.
6 University of Montreal, Montreal, Canada
7 University of Rochester, Rochester, NY
8 Cardiology Consultants, Calgary, Canada
9 Medstar Research Institute, Washington, DC
10 Yale University School of Medicine (Department of Internal Medicine, Section of Endocrinology), New Haven, CT

frans.wackers{at}yale.edu

ABSTRACT

Objective: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, revascularization or unable/unwilling to repeat 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, while 28 (10%) developed new ischemia in DIAD-2. Of the 71 patients with abnormal DIAD-1 studies, 56 (79%) demonstrated resolution of ischemia, while 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=.04).

Conclusion: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.


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