Introduction: Screening silent myocardial ischemia in asymptomatic patients with type 2 diabetes is still controversial. The purpose of the present study was to define the value of diabetic foot ulcer (DFU) in the prediction of silent myocardial ischemia in asymptomatic men and women with type 2 diabetes. Methods: We performed a cross sectional study on 150 diabetic patients with DFU, as cases, and 90 diabetic patients, without the history of any type of DFU, as controls. Presence of silent myocardial ischemia was assessed by dipyridamole single-photon emission- computed tomography myocardial perfusion (SPECT) imaging with thallium-201. Results: Patients with DFU had longer diabetes duration, higher serum HbA1C, and lower serum high density lipoprotein cholesterol levels, compared to patients without DFU. There were a greater number of women with silent myocardial ischemia (28/63 (44.4%) vs. 28/87 (32.2%); p<0.05) in patients with DFU compared to men. There were a greater number of men with silent myocardial ischemia compared to women (10/47(21.3%) vs. 2/43 (4.7%); p<0.05) in patients without DFU. Logistic regression analysis demonstrated that the odds ratio of having silent myocardial ischemia was 2.96 in women with DFU, 0.18 in women without DFU and 1.75 in men with DFU compared to men without DFU, adjusting for HbA1c, HDL-C and diabetes duration. Discussion: Women with DFU are at an increased risk of having silent myocardial ischemia, compared to male counterparts.