{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T15:13:38Z","timestamp":1782573218301,"version":"3.54.5"},"reference-count":15,"publisher":"BMJ","issue":"6743","license":[{"start":{"date-parts":[[1990,7,14]],"date-time":"1990-07-14T00:00:00Z","timestamp":647913600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1990,7,14]]},"abstract":"<jats:p>OBJECTIVE--To compare the prevalence of silent myocardial ischaemia associated with coronary artery disease in diabetic subjects with that in controls of similar age and sex. DESIGN--A controlled study in which subjects with positive findings on exercise electrocardiography, 24 hour electrocardiographic recording, or dynamic thallium scintigraphy (diabetics only) underwent coronary angiography. SETTING--Academic medical centre; referral based cardiology clinic. SUBJECTS--136 Diabetic subjects, of whom 72 (33 women, 39 men (mean age 46.0] were insulin dependent and 64 (19 women, 45 men (mean age 49.3] non-insulin dependent. 80 Controls matched for age and sex; all were clients of the Occupational Health Service of Oulu University Central Hospital or the State Occupational Health Service Station in Oulu in whom diabetes had been excluded by a glucose tolerance test. INTERVENTIONS--Any subject showing signs of myocardial ischaemia was referred for cardiac catheterization. MAIN OUTCOME MEASURES--Exercise electrocardiography and 24 hour electrocardiographic recording were regarded as positive if there were ST depressions of greater than or equal to 1 mm that were planar or downsloping and persisted for 0.08 seconds after the J point. Thallium tomographic imaging. With cardiac catheterisation, coronary artery lesions were classified as significant in half or more of the vessel lumen was narrowed, or insignificant if such narrowing was less than half. RESULTS--40 (29%) diabetes and four (5%) controls had positive results in one or more of the non-invasive tests. Coronary angiography was performed on 34 of the diabetics (six refused); 12 had significant coronary artery narrowing; seven had unimportant atherosclerosis; 15 had patent coronary arteries. Among the controls only one had unimportant atherosclerosis; the other three had patent arteries. CONCLUSIONS--These results confirm the high prevalence of asymptomatic myocardial ischaemia in diabetics. Non-invasive screening of diabetic subjects, however, does not seem justified because of the low preset probability of the presence of the disease and the inaccuracy of the available test methods.<\/jats:p>","DOI":"10.1136\/bmj.301.6743.92","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"92-95","source":"Crossref","is-referenced-by-count":169,"title":["Prevalence of asymptomatic myocardial ischaemia in diabetic subjects."],"prefix":"10.1136","volume":"301","author":[{"given":"M J","family":"Koistinen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1990,7,14]]},"reference":[{"issue":"79","key":"ref_1","first-page":"2","article-title":"Silcint mvocardial ischemia: classification, prevalence and prognosis","volume":"1985","author":"P'F, Cohn","unstructured":"Cohn P'F. Silcint mvocardial ischemia: classification, prevalence and prognosis. Am_7Med 1985,79 suppl 3Ai:2-6.","journal-title":"Am_7Med"},{"key":"ref_2","first-page":"1144","article-title":"'FR, McNamara PMI. Clinical features of unirecognized mvocardial inf; arction: an oipdate on the Framingham stud. \\ Engl","volume":"311","author":"Margolis, JR, Kannel; WB, Feinleib; M, D.)awber","year":"1984","unstructured":"Margolis JR, Kannel WB, Feinleib M, D)awber 'FR, McNamara PMI. Clinical features of unirecognized mvocardial inf;arction: an oipdate on the Framingham stud. \\ Engl 7 Mled 1984;311:1144-7."},{"issue":"17","key":"ref_3","first-page":"322","article-title":"Diminished pain in diabetic patients with acute my ocardial infarction","volume":"1962","author":"Bradlc, R.F.; Schonfeld, A.","unstructured":"Bradlc RF, Schonfeld A. Diminished pain in diabetic patients with acute my ocardial infarction Geriatrics 1962;17:322-6.","journal-title":"Geriatrics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.1001\/jama.1979.03290450033020","article-title":"Diabetes and cardiosvascular disease. 'I'he Framingham study","volume":"241","author":"1)L, Kannel WB. McGee","year":"1979","unstructured":"Kannel WB. McGee 1)L. Diabetes and cardiosvascular disease. 'I'he Framingham study. JAMA 1979;241:2035-8.","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/BF01219704","article-title":"Differences in cardiovascular morbiditv and mortality bctween previiouslv known and newly diagnosed adult diabetics","volume":"13","author":"Herman, J.B.; Medalic, J.H.; Goldbourt, U.","year":"1977","unstructured":"Herman JB, Medalic JH, Goldbourt U. Differences in cardiovascular morbiditv and mortality bctween previiouslv known and newly diagnosed adult diabetics. Diabetologia 1977;13:229-34.","journal-title":"Diabetologia"},{"key":"ref_6","first-page":"5","article-title":"Clinical exercise testing. Standards for procedtires and recommendations for the interpretation. Publicatilons of the Social Insurance Itistitution, Finland","volume":"34","author":"Arstila, M.; Kallio, V.; Seppanen, A.","year":"1984","unstructured":"Arstila M, Kallio V, Seppanen A. Clinical exercise testing. Standards for procedtires and recommendations for the interpretation. Publicatilons of the Social Insurance Itistitution, Finland 1984;34:5-7."},{"key":"ref_7","first-page":"1110","article-title":"Lef't ventricular response to isometric exercise and its value in predicting the change in ventricular function after mitral valve replacement for mitral regurgitation","volume":"51","author":"HVt, Huikuri; IkaheimoMj, LinnaluotoIMMK; TakkunenJF","year":"1983","unstructured":"Huikuri HVt, IkaheimoMj, LinnaluotoIMMK,TakkunenJF. 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Am Heartj 1985;110:529-34.","journal-title":"Am Heartj"},{"key":"ref_9","first-page":"170","article-title":"Angina and exertional myocardial ischemia in diabetic and non-diabetic patients: assessment by exercise thallium scintigraphy","volume":"108","author":"Nesto, R.W.; I'hillips, R.T.; Kett, K.G.","year":"1988","unstructured":"Nesto RW, I'hillips RT, Kett KG, et al. Angina and exertional myocardial ischemia in diabetic and non-diabetic patients: assessment by exercise thallium scintigraphy. Ann Intern led 1988;108:170-5."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1161\/01.CIR.36.2.245","article-title":"The exercise test in diabetic patients as studied by radioelectrocardiographv","volume":"36","author":"Bellet, S.; Roman, L.","year":"1967","unstructured":"Bellet S, Roman L. The exercise test in diabetic patients as studied by radioelectrocardiographv. Circulation 1967;36:245-54.","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1161\/01.CIR.63.1.54","article-title":"Exercise testing with myocardial scintigraphv in asymptomatic diabetic males","volume":"63","author":"Abenavoli, T.; Rubler, S.; Fisher, V.J.; Axelrod, H.I.; KIl, Zuckerman","year":"1981","unstructured":"Abenavoli T, Rubler S, Fisher VJ, Axelrod HI, Zuckerman KIl. Exercise testing with myocardial scintigraphv in asymptomatic diabetic males. Circulation 1981;63:54-64.","journal-title":"Circulation"},{"key":"ref_12","first-page":"156","article-title":"Follow up of patients with asymptomatic mvocardial ischemia","author":"Erikssen, J.; Thaulow, E.","year":"1984","unstructured":"Erikssen J, Thaulow E. Follow up of patients with asymptomatic mvocardial ischemia. In: Rutishauser W, Roskamm H, eds. Silent myocardial ischemia. Berlin: Springer Verlag, 1984:156-64."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/0033-0620(76)90022-0","article-title":"Value of cxercise testing for screening asvmptomatic men for latent coronary artery disease","volume":"18","author":"Froelicher, V.F.; TIhompson, A.J.; MR, Jr, Longo; Triebwasser, J.H.; Lancaster, I.C.","year":"1976","unstructured":"Froelicher VF, TIhompson AJ, Longo MR Jr, Triebwasser JH, Lancaster IC. Value of cxercise testing for screening asvmptomatic men for latent coronary artery disease. Prog Cardtovzasc Dis 1976;18:265-76.","journal-title":"Prog Cardtovzasc Dis"},{"key":"ref_14","first-page":"583","article-title":"The heart in diabetes","volume":"14","author":"Kereiakes, D.J.; Naughton, J.L.; Brundage, B.; Schiller, N.B.","year":"1984","unstructured":"Kereiakes DJ, Naughton JL, Brundage B, Schiller NB. The heart in diabetes. 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