Main Article Content

Ghulam Fareed shah
Jagdesh Kumar
Muhammad Khan Soomro
Mashooque Ali Dasti
Shabnam Rani
Gul Hassan Brohi


Type II DM, Silent, Myocardial infarction


Objective: To determine the frequency of silent myocardial infraction (SMI) among patients with type II diabetes mellitus.

 Material And Methods Setting: This cross-sectional study was conducted at the Cardiology Department of Liaquat University Hospital in Hyderabad from March 2020 to August 2020. The study included patients diagnosed with type II diabetes mellitus for over 5 years, aged between 40 and 60 years, of both genders, with a respiratory rate more than 20/minute, and confirmed cases of myocardial infarction. Silent myocardial infarction was diagnosed based on established criteria, including ECG changes indicative of myocardial ischemia, imaging evidence of myocardial scar or regional wall motion abnormalities consistent with prior infarction, and the absence of typical symptoms of acute coronary syndrome. All data were entered into SPSS version 16.0 for analysis.

Results: In this study mean of patients was 59.29+12.96 years, mean systolic blood pressure was 134.82+33.57, mean diastolic blood pressure was 82.11+17.98. Males were 54.4% and females were 45.6%. Mean HbA1c level was 11.30+2.90, mean cardiac troponin was 46.0+136.98. However mean duration of diabetes was 11.30+7.46 years. Majority of the patients 61.0% were presented with non-St Elevation MI, while 39.0% were diagnosed as ST elevation MI. Frequency of silent myocardial infarction, 44.1% patients had silent myocardial infarction and 55.9% were without silent myocardial infarction. Frequency of silent myocardial infarction was statistically insignificant according to age, gender, duration of disease, HbA1c and blood pressure, p-values were quite insignificant.

Conclusion: In the conclusion of this study the frequency of silent myocardial infarction was highly prevalent (42.1%) among patients of myocardial infarction with diabetes mellitus type II. However, this prevalence was statistically insignificant according to age, gender, HbA1c, duration of disease and blood pressure


Abstract 13 | PDF Downloads 6


1. Dua HS, Anand M. The study of correlation of silent myocardial ischemia with microalbuminuria in patients of type 2 diabetes mellitus. Int J Adv Med 2017;4(6):1506-12
2. Singleton MJ, German CA, Bertoni AG, Ambrosius WT, Bhave PD, Soliman EZ, Yeboah J. Association of silent myocardial infarction with major cardiovascular events in diabetes: the ACCORD trial. Diabetes Care. 2020 Apr 1;43(4):e45-6.
3. Fokoua-Maxime CD, Lontchi-Yimagou E, Cheuffa-Karel TE, Tchato-Yann TL, Pierre-Choukem S. Prevalence of asymptomatic or “silent” myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis. PloS one. 2021 Jun 10;16(6):e0252511.
4. Emami T, Naeimei Z, Salehifard A, Azizmohammadi Z, Iranpour D, Kalantarhormozi M, Jafari E, Gholamrezanezhad A, Assadi M. Significance of microalbuminuria in predicting silent myocardial ischemia in patients with type 2 diabetes using myocardial perfusion imaging. Molecular Imaging and Radionuclide Therapy. 2019 Jun;28(2):62.
5. de Kreutzenberg SV. Silent coronary artery disease in type 2 diabetes: A narrative review on epidemiology, risk factors, and clinical studies. Exploration of Medicine. 2021 Feb 28;2(1):1-9.
6. Nguyen MT, Pham I, Valensi P, Rousseau H, Vicaut E, Laguillier-Morizot C, Nitenberg A, Cosson E. Flow-mediated-paradoxical vasoconstriction is independently associated with asymptomatic myocardial ischemia and coronary artery disease in type 2 diabetic patients. Cardiovascular Diabetology. 2014 Dec;13(1):1-1.
7. Xu J, Zou MH. Molecular insights and therapeutic targets for diabetic endothelial dysfunction. Circulation. 2009; 120:1266-86.
8. Barthelemy O, Le Feuvre C, Timsit J. Silent myocardial ischemia screening in patients with diabetes mellitus. Arquivos Brasileiros de Endocrinologia & Metabologia. 2007;51(2):285-93.
9. Arnold SV, Spertus JA, Lipska KJ, Tang F, Goyal A, McGuire DK et al. Association between diabetes mellitus and angina after acute myocardial infarction: analysis of the TRIUMPH prospective cohort study. European journal of preventive cardiology. 2015 Jun;22(6):779-87.
10. Zia N, Aftab S, Butt NI, Ashfaq F, Anser A, Saeed S. Prevalence of silent cardiac ischemia in type II diabetes mellitus. Pakistan Heart Journal. 2021;54(2):162-6.
11. Sadiq T, Khalid Z, Theba FK, Naz K, Tareen M, Saleem A. Determine the Frequency of Silent Cardiac Ischemia in Type II Diabetes Mellitus Patients. Pakistan Journal of Medical & Health Sciences. 2022 Dec 20;16(10):863-.
12. Khan HA, Shuaib M, Sabir S, Aimen A, Bukhari M, Irfan M. SILENT MYOCARDIAL ISCHEMIA IN TYPE 2 DIABETIC PATIENTS WITH MICROALBUMINURIA. Gomal Journal of Medical Sciences. 2023 Jul 4;21(2):71-5.
13. Ali FS, Bader N, Zuberi BF, Banu S. Frequency of silent carotid artery stenosis in diabetics and its associated factors: An analysis in tertiary care hospital. Pakistan Journal of Medical Sciences. 2020 Sep;36(6):1270.
14. Ejaza M, Tariqa Z, Sabirb A, Kalimullaha CM, Sadiqa Z. FrequenCy OF SIlenT MyOCArDIAl ISCheMIA In pATIenTS wITh DIAbeTIC nephrOpAThy. The Journal. 2018;14(4):104.
15. Memon S. Frequency of Mortality and Risk Factors Associated to Acute Myocardial Infarction in Pakistan. Tobacco Regulatory Science (TRS). 2023 Apr 4:1298-305.
16. Prasad DS, Kabir Z, Devi KR, Peter PS, Das BC. Prevalence and Risk factors for Silent Myocardial ischemia (PRISM): A clinico observational study in patients of type 2 diabetes. Indian Heart Journal. 2019 Sep 1;71(5):400-5.
17. Scheidt-Nave C, Barrett-Connor E, Wingard DL. Resting ECG abnormalities suggestive of asymptomatic IHD associated with NIDDM in a defined population. Circulation 2010; 81: 899-906
18. Ihsan A, Khan SB. Silent myocardial ischemia among asymptomatic type-2 diabetic patients. Journal of Postgraduate Medical Institute. 2022 Mar 31;36(1):20-4.
19. Sharrack N, Brown LA, Farley J, Wahab A, Jex N, Thirunavukarasu S, Chowdhary A, Gorecka M, Javed W, Xue H, Levelt E. 8 Adverse cardiovascular outcomes in diabetic patients with heart failure are mediated by silent myocardial infarction.
20. Hafsa FA, Zaman SH, Mahmood AU. Frequency of asymptomatic myocardial ischemia in type 2 diabetic patients with microalbuminuria. PJMHS. 2020;14(1):567-70.
21. El-Hefny E, El-Din AM, Sadek A, Abbas E. The degree of retinopathy correlates with the presence of silent myocardial ischemia in diabetic patients. European Heart Journal. 2020 Nov 1;41(Supplement_2):ehaa946-3048.

Most read articles by the same author(s)