Anurag S Lavekar and Harsha R Salkar
Background: Progressive Coronary Artery Disease (CAD) remains asymptomatic in many cases of type 2 diabetes mellitus (DM) and this makes diagnosis difficult. Routine screening of type 2 DM for silent ischemia with electrocardiography (ECG) remains controversial as majority of patients present with normal ECG. This study aims at using Treadmill Test (TMT) to determine the percentage of ischemic heart disease (IHD) in diabetic patients, having normal resting ECG and 2D Echo, in a rural set up of Central India. Moreover, the interest is to determine the risk factors for IHD in patients who underwent TMT.
Materials and methods: One hundred sixty one type 2 DM patients in the age range 30-60 years with normal baseline ECG and resting Echo were screened by TMT. The data on demographics, biochemical tests and micro vascular complications was obtained for each patient to determine the possible risk factors of IHD in this study population.
Results: Thirty four out of 161 patients (21.1%) were found positive for exercise induced ischemia. Of these, 27 underwent exercise stress echo immediately after TMT and the presence of RWMA was confirmed in 20 patients. Age, duration of DM and family history of IHD were identified as major covariates in the study. The parameters like HbA1C (glycosylated hemoglobin), total cholesterol (TC), triglycerides (TG) and low density lipoprotein (LDL) showed marginal increase of odds in favor of TMT positive result after adjusting for covariates. Nephropathy and retinopathy were associated with silent ischemia in the study population exposed to TMT.
Discussion: The study group belonged to lower socioeconomic group with mostly moderate to heavy working life style. Patients had normal resting echo, but when subjected to TMT, a significant proportion of cases were positive for silent ischemia, which otherwise would have been unnoticed. We believe that TMT remains the cornerstone for screening the population at risk in the rural sector where angiography is not readily available.
