Assessing Risk Factors for Silent Myocardial Ischemia in Adults with Type 2 Diabetes: A Cross-Sectional Study

Background: Silent myocardial ischemia (SMI) is an insidious but lethal form of coronary artery disease, especially in persons with type 2 diabetes mellitus (T2DM). It is often asymptomatic, which results in late diagnosis and risk of negative cardiac outcomes. The purpose of this study was to evaluate the prevalence and risk factors of SMI in adults having T2DM. Methods: This cross-sectional study was conducted between February and July 2025 in the cardiology and endocrinology departments of a tertiary care facility. Non-probability purposive sampling was used to recruit 150 adults aged 35-70 years with a confirmed diagnosis of T2DM for more than five years. The participants were subjected to resting electrocardiography (ECG), treadmill stress test, and laboratory profiling of HbA1c, lipids, and renal tests. Statistical analysis with SPSS version 26.0 consisted of a chi-square test to compare categorical variables and logistic regression for confounder adjustment, where p < 0.05 was considered significant. Results: The prevalence of SMI was 58 (38.6%). The most significant relations observed were the duration of diabetes (10 years or more) (OR: 3.75; CI: 1.87-7.53), poor glycemic control (HbA1c above 8%) (OR: 3.37; CI: 1.69 – 6.71), hypertension (OR: 2.57; CI:1.24 – 5.31), and microalbuminuria (OR: 2.95; CI: 1.45 – 6.01). Dyslipidemia was nearly significant, whereas gender, BMI, and smoking were not relevant to SMI. Conclusion: SMI is widespread in asymptomatic T2DM patients. Metabolic and renal risk markers could be identified to facilitate earlier screening and intervention to lower the risk of unrecognized cardiac outcomes.