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Circulation, Vol 81, 899-906, Copyright © 1990 by American Heart Association
C Scheidt-Nave, E Barrett-Connor and DL Wingard
The prevalence of ischemic heart disease (IHD) in older adults by glucose
tolerance status was evaluated in 2,223 white men and women, aged 50-89
years, in the Rancho Bernardo cohort who were studied between 1984 and
1987. Impaired glucose tolerance (IGT) and non-insulin- dependent diabetes
mellitus (NIDDM) were classified according to World Health Organization
criteria. End points of ischemic heart disease were defined by Rose
Questionnaire and resting electrocardiogram (ECG) according to the
Minnesota Code. IHD by electrocardiographic changes was classified as
asymptomatic (without history of chest pain or overt IHD) or symptomatic
(with history). IHD by all criteria combined was significantly more common
in men and women with NIDDM, and in women with IGT, than in those with
normal glucose tolerance. The prevalence of myocardial infarction, defined
by major Q wave, Rose Questionnaire chest pain criteria, or personal
history, was higher in persons with NIDDM than in persons without; the
difference was highly significant in women (odds ratio, 2.08 [1.22, 3.56];
p = 0.009). Angina pectoris was not significantly related to NIDDM or IGT
in either sex. Electrocardiographic evidence of asymptomatic IHD was
significantly more prevalent in both men and women with NIDDM as compared
with those with normal glucose tolerance (odds ratios, 1.75 [1.10, 2.81]
for men and 1.80 [1.07, 3.01] for women; p less than 0.05). This
significant association persisted after excluding persons on digitlis or
diuretic therapy and, in women, was also independent of the effect of major
known IHD risk factors. These population-based data are consistent with
clinical reports suggesting an association of diabetes with silent
myocardial infarction or ischemia. The presence of ischemic resting
electrocardiographic abnormalities in the asymptomatic diabetic patient is
likely to have prognostic and therapeutic implications.
ARTICLES
Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population
Department of Community and Family Medicine, University of California San Diego, School of Medicine 92093.
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