Assessment of Asymptomatic Coronary Heart Disease in Type 2 Diabetics with Treadmill Test and Framingham 10-Year CHD Risk Scoring System

Abstract

Background and objectives: Coronary Heart Disease (CHD) has a high prevalence in Asian Indians & is the leading cause of morbidity & mortality in patients with Type 2 diabetes due to silent myocardial ischemia. This needs early cardio vascular assessment through non invasive tests e.g. Treadmill Test (TMT) & Framingham 10-year CHD risk in addition to periodical clinical examination & resting electrocardiogram. Methods: 102 known north Indian diabetics without clinical & electrocardiographic evidence of CHD were evaluated for smoking, blood pressure, glycosylated hemoglobin, fasting & post-prandial blood sugar & lipid profile to calculate Framingham score system for 10-year CHD risk assessment along with exercise treadmill test. Results: Among 102 diabetic patients, TMT was positive in 32 (31.37%) patients; more in males (59.73%). Mean cholesterol (189.81 mg %), triglycerides (135.19 mg %) and LDL (116.28 mg %) levels were significantly high in TMT positive cases (P<0.001). A significantly higher mean duration of diabetes (8.87 years) in TMT positive cases, in which 21.31%, 33.33%, 70% & 75% cases are of ≤5 years, 6-10 years, 11-15 years & 16-20 years of diabetes; respectively. Mean BMI (30.41 kg/m 2) was significantly high in TMT positive cases (P<0.0001) as well as in males (mean BMI 29.46 kg/m 2 , P<0.001). Mean Framingham 10-year CHD risk in males (18.59%) is more than females (13.47%); also significantly high (22.91%) in TMT positive cases (p<0.0001). TMT positive cases 19 (82.60%), 10 (35.71%) & 3 (5.88%) were found in 23 high (>20%), 28 intermediate (≥10-19.9%) & 51 low (<10%) Framingham 10-year CHD risk groups, respectively. Conclusion: A 6-fold higher incidence between low & intermediate, 2.4-fold between intermediate & high and 14-fold between low & high Framingham 10-year CHD risk groups is suggestive of higher incidence of TMT positive cases correlates with higher Framingham 10-year CHD risk & are more prone for asymptomatic CHD in north Indian diabetics.