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Abstract

Introduction: Silent myocardial ischemia (SMI) is a clinically asymptomatic condition characterized by ischemic changes without anginal symptoms, commonly observed in patients with type 2 diabetes mellitus (T2DM). It contributes significantly to cardiovascular morbidity and mortality due to delayed diagnosis and treatment.
Objective: To determine the prevalence and predictors of silent myocardial ischemia among patients with type 2 diabetes mellitus at a tertiary care hospital in Peshawar.
Methodology: This cross-sectional study was conducted from January to September 2024 at the Lady Reading Hospital (LRH), Peshawar, in the Department of Cardiology. A total of 300 patients aged 35–70 years with T2DM were enrolled through consecutive sampling. Participants underwent a resting electrocardiogram (ECG) and treadmill exercise stress testing, while those unable to exercise underwent pharmacologic stress testing. SPSS version 26.0 was used to analyze the data, and logistic regression was used to find independent predictors of SMI.
Results: The prevalence of SMI was 27.7%. SMI was more common among males (60.2%), patients with hypertension (63.9%), and those with poor glycemic control (65.1 %) (HbA1c ≥ 8%). On multivariate analysis, poor glycemic control (AOR 2.78; p=0.002) and a longer duration of diabetes ≥10 years (AOR 2.41; p=0.008) were significant predictors of SMI.
Conclusion: Silent myocardial ischemia is highly prevalent among patients with T2DM, particularly in those with prolonged disease duration and poor glycemic control. Regular cardiovascular screening and strict metabolic management are crucial for early detection and prevention of complications.