Abstract
BACKGROUND: Silent myocardial ischemia (SMI) is a common but frequently overlooked manifestation of coronary artery disease in patients with diabetes mellitus, largely due to autonomic neuropathy and atypical symptom presentation. OBJECTIVE: To determine the frequency of SMI in diabetic patients presenting with non-cardiac complaints using electrocardiography (ECG), serum troponin-I, and non-invasive stress testing, and to assess its association with clinical risk factors. METHODS: This cross-sectional observational study was conducted at Niazi Medical and Dental College, Niazi Welfare Foundation Teaching Hospital, from June 2023 to June 2024. A total of 255 diabetic patients were enrolled through consecutive non-probability sampling. Data were collected on demographics, duration of diabetes, associated comorbid conditions (e.g., hypertension, dyslipidemia), and current medications. Investigations included a resting 12-lead ECG, random blood glucose, serum troponin-I, HbA1c, and lipid profile. RESULTS: The mean age of participants was 56.8 ± 10.9 years, and 56.5% were male. Ischemic changes on ECG were noted in 43 patients (16.9%), and 12 patients (4.7%) had elevated troponin-I levels. Stress testing was performed in 55 patients, confirming SMI in 39 (15.3%). SMI was significantly associated with a duration of diabetes >10 years (p = 0.02), HbA1c >8% (p < 0.01), and hypertension (p = 0.04). No significant association was found with age (p = 0.09) or gender (p = 0.19). CONCLUSION: SMI is prevalent in diabetic patients presenting with non-cardiac complaints, with poor glycemic control and long-standing diabetes being strong predictors. Routine cardiac screening should be considered in high-risk asymptomatic diabetics to enable early detection and timely intervention.