ASNC: Ischemia Resolution in Diabetes Tied to Risk Factor Control

SAN DIEGO, Sept. 11 -- There was unexpected resolution of silent myocardial ischemia for almost 80% of diabetic patients over three years, possibly because of aggressive therapy, according to a study reported here.

SPECT perfusion imaging showed that 56 of 71 (79%) patients with abnormal initial scans had resolution of ischemia at follow-up imaging three years later, Frans Wackers, M.D., of Yale reported at the American Society of Nuclear Cardiology meeting. The study results were published simultaneously in the September issue of Diabetes Care.

Patients with ischemia resolution were significantly more likely to receive ACE inhibitors, statins, and aspirin, in accordance with American Diabetes Association recommendations for coronary risk reduction (P=0.03 to P

When investigators evaluated the change in medication usage between perfusion stress tests, they found that 34% of patients were on ACE inhibitors at baseline, 40% were on statins, and 42% were taking aspirin. Three years later, the figures were 42% for ACE inhibitors, 59% for statins, and 69% for aspirin.

Analysis of medication usage in the 56 patients who had resolution of ischemia showed that 50% were on ACE inhibitors at three years, 63% were on statins, and 71% were taking aspirin. In contrast, medication usage among the 28 patients with new ischemia was 39% for ACE inhibitors, 50% for statins, and 61% for aspirin.

Moreover, patients who had resolution of asymptomatic ischemia had a median exposure to the three medications combined of 59 months, compared with 45 months for the patients with new ischemia (P=0.04).

Data on cardiac event rates are not yet available. However, Dr. Wackers said, the results provide strong support for aggressive treatment of cardiac risk factors in patients with type 2 diabetes.