Cornelia Junghans1, Neha Sekhri2, M Justin Zaman3, Harry Hemingway1,4, Gene S Feder5, Adam Timmis6. 1. Department of Epidemiology and Public Health, University College London, London, UK. 2. Barts Health, London Chest Hospital, London, UK. 3. James Paget University Hospital, Norfolk NR31 6LA, UK. 4. Farr Institute of Health Informatics Research at London, London, UK. 5. Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK. 6. Dept Cardiology, Barts Heart Centre, Queen Mary University London, West Smithfield, London EC1A 7BE, UK.
Abstract
AIMS: Silent myocardial ischaemia occurs commonly in diabetes. Whether altered perception of ischaemia also predisposes to atypical presentations with under-diagnosis of coronary disease is not known. To determine whether (i) patients with diabetes diagnosed with angina are more likely to report atypical symptoms compared with patients without diabetes, and (ii) atypical symptoms in patients with diabetes cause angina to go unrecognized, increasing the risk of coronary events. METHODS AND RESULTS: Prospective, multicentre cohort study of 8662 ambulatory patients with suspected angina, of whom 906 had diabetes. We recorded detailed chest pain descriptors and fatal and non-fatal coronary events over a median of 3.08 years of follow-up. Proportionately more patients with than without diabetes received a diagnosis of angina (42.7 vs. 25.1%). Among patients with diabetes diagnosed with angina, a greater proportion had atypical chest pain compared with patients without diabetes (21.0 vs. 11.3%), but the hazard of fatal and non-fatal coronary events was similar. However, among patients diagnosed with non-cardiac chest pain, those with diabetes-most of whom had atypical symptoms-remained at greater risk of coronary events [2.29 (95% CI 1.54, 3.41)] and all-cause mortality [1.67 (95% confidence interval, CI 1.04, 2.69)] compared with non-diabetic patients. CONCLUSION: Patients with diabetes and atypical symptoms are nearly twice as likely to be diagnosed with angina compared with non-diabetic patients. Those diagnosed with non-cardiac pain are at increased risk of coronary events. Our study emphasizes the need for more intensive investigation of diabetic patients with chest pain, particularly those presenting with atypical symptoms.
AIMS: Silent myocardial ischaemia occurs commonly in diabetes. Whether altered perception of ischaemia also predisposes to atypical presentations with under-diagnosis of coronary disease is not known. To determine whether (i) patients with diabetes diagnosed with angina are more likely to report atypical symptoms compared with patients without diabetes, and (ii) atypical symptoms in patients with diabetes cause angina to go unrecognized, increasing the risk of coronary events. METHODS AND RESULTS: Prospective, multicentre cohort study of 8662 ambulatory patients with suspected angina, of whom 906 had diabetes. We recorded detailed chest pain descriptors and fatal and non-fatal coronary events over a median of 3.08 years of follow-up. Proportionately more patients with than without diabetes received a diagnosis of angina (42.7 vs. 25.1%). Among patients with diabetes diagnosed with angina, a greater proportion had atypical chest pain compared with patients without diabetes (21.0 vs. 11.3%), but the hazard of fatal and non-fatal coronary events was similar. However, among patients diagnosed with non-cardiac chest pain, those with diabetes-most of whom had atypical symptoms-remained at greater risk of coronary events [2.29 (95% CI 1.54, 3.41)] and all-cause mortality [1.67 (95% confidence interval, CI 1.04, 2.69)] compared with non-diabetic patients. CONCLUSION: Patients with diabetes and atypical symptoms are nearly twice as likely to be diagnosed with angina compared with non-diabetic patients. Those diagnosed with non-cardiac pain are at increased risk of coronary events. Our study emphasizes the need for more intensive investigation of diabetic patients with chest pain, particularly those presenting with atypical symptoms.
Authors: Abhinav Sharma; Adrian Coles; Nishant K Sekaran; Neha J Pagidipati; Michael T Lu; Daniel B Mark; Kerry L Lee; Hussein R Al-Khalidi; Udo Hoffmann; Pamela S Douglas Journal: J Am Coll Cardiol Date: 2019-03-05 Impact factor: 24.094
Authors: Halidah Manistamara; Yurike Olivia Sella; Sony Apriliawan; Mifetika Lukitasari; Mohammad Saifur Rohman Journal: J Public Health Res Date: 2021-04-14
Authors: Abhinav Sharma; Nishant K Sekaran; Adrian Coles; Neha J Pagidipati; Udo Hoffmann; Daniel B Mark; Kerry L Lee; Hussein R Al-Khalidi; Michael T Lu; Patricia A Pellikka; Quynh A Truong; Pamela S Douglas Journal: J Am Heart Assoc Date: 2017-10-31 Impact factor: 5.501