Abstract 12778: 44 % of Patients With Myocardial Infarction are Silent Manifestation in Diabetics
Background: Diabetes mellitus is well known as a significant predictor of silent myocardial ischemia. The incidence rates of silent events with newly developed Q waves, (especially, silent myocardial infarction (SMI)) in diabetic patients, have yet to be elucidated. We sought to evaluate the prevalence and predictors of SMI in type 2 diabetic patients without a history of atherosclerotic events.
Methods: The Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial was performed to examine the efficacy of low-dose aspirin therapy for the primary prevention of atherosclerotic events in type 2 diabetes patients. Initially, there were no Q waves in any electrocardiograms (ECGs). The JPAD trial was a multicenter, prospective, randomized, open label, blinded, end-point study done from 2002 to 2008. After completion of the JPAD trial, we followed up the patients until 2015. ECGs of 1648 patients were re-examined to discover SMI in 2013 and 2015. We compared predictive factors for SMI to those for acute myocardial infarction (AMI).
Results: During follow up of a median of 10.3 years, 64 patients suffered from a first AMI and 51 patients suffered from a first SMI. We novelly demonstrated that the incidence rate of SMI is comparable to that of AMI in diabetic patients (Figure). Age, smoking, dyslipidemia, and HbA1c ≥ 7.2 % were all associated with AMI. Hypertension was associated with SMI. Cox proportional hazards model analysis revealed that age ≥ 65 years and HbA1c ≥ 7.2 % were independent factors for AMI (P=0.0003, 0.0214, respectively, Figure). On the other hand, there were no significant independent factors for SMI.
Conclusions: Our study demonstrates that age ≥ 65 years and HbA1c ≥ 7.2 % were independently associated with the incidence rate of AMI, but they were not associated with the incidence rate of SMI. Clinically, diabetic patients should frequently get ECGs for the detection of SMI because the rate of SMI is similar to AMI rates.
Author Disclosures: H. Soejima: Other Research Support; Modest; Boehringer Ingelheim Japan. T. Morimoto: Other Research Support; Significant; Nexis Co.,Ltd. Speakers Bureau; Modest; AbbVie Inc, AstraZenca K.K., Daiichi-Sankyo Co., Ltd. S. Okada: None. M. Sakuma: None. M. Nakayama: None. H. Jinnouchi: None. S. Sugiyama: None. M. Waki: None. Y. Saito: Other Research Support; Modest; Nihon Medi-Physics, Chugai, Genzyme Japan, Medtronic, Pfizer Japan. Other Research Support; Significant; MSD, Daiichi-Sankyo, Bayer, Baxter, Outsuka, Kyowa Hakko Kirin, Dainippon Sumitomo, Astetellas, Takeda, Ono, Teijin, Mitsubishi Tanabe, Eisai, ZERIA. Honoraria; Modest; Otsuka, Takeda, Daiichi-Sankyo, MSD, Novartis, Byer, Kyowa Hakko Kirin, Astellas, Ono, Pfizer Japan. Consultant/Advisory Board; Modest; Novartis, Ono, Pfizer Japan. H. Ogawa: Other Research Support; Modest; Eisai, Otssuka, Sanofi, Takeda, Teijin, Terumo. Other Research Support; Significant; Abbot, Byer, Boehringer Ingelheim, Boston Scientific, Chugai, Daiichi-Sankyo, Dainippon Sumitomo, Fukuda Denshi, Johnson & Johoson, Medtronic, Mitsubishi Tanabe, Mochida, Nihon Kohden, Novartis, Ono,. Honoraria; Modest; AstraZeneca, Eisai, Otsuka, Takeda, Teijin. Honoraria; Significant; Byer, Daiichi-Sankyo, MSD.
- © 2016 by American Heart Association, Inc.