Prevalence, Incidence, and Implications of Silent Myocardial Infarctions in Patients With Diabetes Mellitus

Scirica, Benjamin M.

doi:10.1161/circulationaha.113.001180

Cited by 20 publications

(12 citation statements)

References 22 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In general, the prevalence of SMI among people with diabetes seems to be higher compared with those who are nondiabetic, 6,16,25 and they have been reported to have high rates of asymptomatic myocardial ischemia. 8 Nonetheless, diabetes was not more prevalent in individuals with SMI than without SMI in the present study.…”

Section: Discussionmentioning

confidence: 95%

Association of Silent Myocardial Infarction and Sudden Cardiac Death

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE Myocardial infarction in the absence of major or unrecognized symptoms are characterized as silent (SMI). The prevalence of SMI among individuals who experience sudden cardiac death (SCD), with or without concomitant electrocardiographic (ECG) changes, has not previously been described in detail from large studies to our knowledge. OBJECTIVE To determine the prevalence of SMI in individuals who experience SCD without a prior diagnosis of coronary artery disease (CAD) and to detect ECG abnormalities associated with SMI-associated SCD. DESIGN, SETTING, AND PARTICIPANTS This case-control study compared autopsy findings, clinical characteristics, and ECG markers associated with SMI in a consecutive cohort of individuals in the Finnish Genetic Study of Arrhythmic Events (Fingesture) study population who were verified to have had SCD. The Fingesture study consists of individuals who had autopsy-verified SCD in Northern Finland between 1998 and 2017. Individuals who had SCD with CAD and evidence of SMI were regarded as having had cases; those who had SCD with CAD without SMI were considered control participants. Analyses of ECG tests were carried out by investigators blinded to the SMI data. Data analysis was completed from October 2018 through November 2018. MAIN OUTCOMES AND MEASURES Silent MI was defined as a scar detected by macroscopic and microscopic evaluation of myocardium without previously diagnosed CAD. Clinical history was obtained from medical records, previously recorded ECGs, and a standardized questionnaire provided to the next of kin. The hypothesis tested was that SMI would be prevalent in the population who had had SCD with CAD, and it might be detected or suspected from findings on ECGs prior to death in many individuals. RESULTS A total of 5869 individuals were included (2459 males [78.8%]; mean [SD] age, 64.9 [12.4] years). The cause of SCD was CAD in 4392 individuals (74.8%), among whom 3122 had no history of previously diagnosed CAD. Two individuals were excluded owing to incomplete autopsy information. An ECG recorded prior to SCD was available in 438 individuals. Silent MI was detected in 1322 individuals (42.4%) who experienced SCD without a clinical history of CAD. The participants with SMI were older than participants without MI scarring (mean [SD] age, 66.9 [11.1] years; 65.5 [11.6] years; P < .001) and were more often men (1102 of 1322 [83.4%] vs 1357 of 1798 [75.5%]; P < .001). Heart weight was higher in participants with SMI (mean [SD] weight, 483 [109] g vs 438 [106] g; P < .001). In participants with SMI, SCD occurred more often during physical activity (241 of 1322 [18.2%] vs 223 of 1798 [12.4%]; P < .001). A prior ECG was abnormal in 125 of the 187 individuals (66.8%) who had SCD after SMI compared with 139 of 251 (55.4%) of those who had SCD without SMI (P = .02). CONCLUSIONS AND RELEVANCE Many individuals who experienced SCD associated with CAD had a previously undetected MI at autopsy. Previous SMI was associated with myocardial hypertrophy and SCD during physical activ...

show abstract

Section: Discussionmentioning

confidence: 95%

Association of Silent Myocardial Infarction and Sudden Cardiac Death

et al. 2019

View full text Add to dashboard Cite

show abstract

“…1 Any phenotype of heart disease significantly associate with diabetes, as recently confirmed in a wide population study, by Shah et al 2 It is also well documented that coronary heart disease (CHD) in diabetes is more severe, 3 and more frequent than in non-diabetic subjects: about 75% of diabetic patients without a diagnosis of CHD show high-grade atherosclerotic coronary lesions, at post-mortem examination. 4 The prevalence of asymptomatic CHD in this population is round 20%, in most studies, [5][6][7][8][9] a figure higher than the non-diabetic individuals; therefore in type 2 diabetes the presence of silent myocardial ischemia is highly probable. Asymptomatic myocardial ischemia predicts cardiovascular events in this population, beyond the routine risk prediction.…”

Section: Introductionmentioning

confidence: 82%

“…This figure is comparable to that of other studies. 5,7,8 On the other hand, a low risk of silent CHD, determined by CV risk factors, or a normal ECG are unlikely to be associated with silent CHD.…”

Section: Discussionmentioning

confidence: 99%

Silent coronary heart disease in patients with type 2 diabetes: application of a screening approach in a follow-up study

Kreutzenberg

Solini

Vitolo

et al. 2017

Journal of Diabetes and its Complications

View full text Add to dashboard Cite

show abstract

“…The comparability of our risk estimates with previous studies suggests that differences between East Asian and Western populations in the relative importance of insulin resistance and beta-cell dysfunction in the aetiology of diabetes [ 9 ] have little, if any, impact on associated IHD risk. The method of ascertainment of IHD in the CKB may misclassify a proportion of individuals with “silent” IHD, which is more prevalent among individuals with diabetes [ 24 ], leading to underestimation of diabetes-associated IHD risk. The more modest effects of screen-detected—compared to self-reported—diabetes may reflect the shorter duration of, or less severe glycaemic aberration in, screen-detected diabetes, and greater potential for misclassification.…”

Section: Discussionmentioning

confidence: 99%

Risks and Population Burden of Cardiovascular Diseases Associated with Diabetes in China: A Prospective Study of 0.5 Million Adults

Bragg

Yang

et al. 2016

PLoS Med

View full text Add to dashboard Cite

BackgroundIn China, diabetes prevalence is rising rapidly, but little is known about the associated risks and population burden of cardiovascular diseases. We assess associations of diabetes with major cardiovascular diseases and the relevance of diabetes duration and other modifiable risk factors to these associations.Methods and FindingsA nationwide prospective study recruited 512,891 men and women aged 30–79 y between 25 June 2004 and 15 July 2008 from ten diverse localities across China. During ~7 y of follow-up, 7,353 cardiovascular deaths and 25,451 non-fatal major cardiovascular events were recorded among 488,760 participants without prior cardiovascular disease at baseline. Cox regression yielded adjusted hazard ratios (HRs) comparing disease risks in individuals with diabetes to those without. Overall, 5.4% (n = 26,335) of participants had self-reported (2.7%) or screen-detected (2.7%) diabetes. Individuals with self-reported diabetes had an adjusted HR of 2.07 (95% CI 1.90–2.26) for cardiovascular mortality. There were significant excess risks of major coronary event (2.44, 95% CI 2.18–2.73), ischaemic stroke (1.68, 95% CI 1.60–1.77), and intracerebral haemorrhage (1.24, 95% CI 1.07–1.44). Screen-detected diabetes was also associated with significant, though more modest, excess cardiovascular risks, with corresponding HRs of 1.66 (95% CI 1.51–1.83), 1.62 (95% CI 1.40–1.86), 1.48 (95% CI 1.40–1.57), and 1.17 (95% CI 1.01–1.36), respectively. Misclassification of screen-detected diabetes may have caused these risk estimates to be underestimated, whilst lack of data on lipids may have resulted in residual confounding of diabetes-associated cardiovascular disease risks. Among individuals with diabetes, cardiovascular risk increased progressively with duration of diabetes and number of other presenting modifiable cardiovascular risk factors. Assuming a causal association, diabetes now accounts for ~0.5 million (489,676, 95% CI 335,777–681,202) cardiovascular deaths annually in China.ConclusionsAmong Chinese adults, diabetes is associated with significantly increased risks of major cardiovascular diseases. The increasing prevalence and younger age of onset of diabetes foreshadow greater diabetes-attributable disease burden in China.

show abstract

Prevalence, Incidence, and Implications of Silent Myocardial Infarctions in Patients With Diabetes Mellitus

Cited by 20 publications

References 22 publications

Association of Silent Myocardial Infarction and Sudden Cardiac Death

Association of Silent Myocardial Infarction and Sudden Cardiac Death

Silent coronary heart disease in patients with type 2 diabetes: application of a screening approach in a follow-up study

Risks and Population Burden of Cardiovascular Diseases Associated with Diabetes in China: A Prospective Study of 0.5 Million Adults

Contact Info

Product

Resources

About