Independent association with the metabolic syndrome in patients with type 2 diabetes.
The aim of this study was to examine whether the metabolic syndrome is associated with angiographically documented silent coronary artery disease (CAD) in patients with type 2 diabetes. The authors analysed the population of two previous studies:

• One study evaluated consecutively 1323 patients with uncomplicated type 2 diabetes without evidence of CAD (clinical or electrocardiographic), of which 103 had CAD documented by angiography. In the 103 controls matched for age, gender and duration of diabetes, exercise electrocardiography (ECG), 48-h ambulatory ECG and stress echography were negative for silent myocardial ischaemia.
• The other study evaluated consecutively 1971 patients with uncomplicated type 2 diabetes without clinical signs of cardiovascular disease and without history of CAD. Patients with ECG abnormalities suggestive of ischaemia or asymptomatic myocardial infarction had a noninvasive test for CAD. Angiographic CAD was found in 75 patients. The tests for silent myocardial ischaemia were negative in the 75 matched controls.

From these two studies, the prevalence of the metabolic syndrome was evaluated in 169 patients with uncomplicated type 2 diabetes and asymptomatic CAD (documented by angiography), and in 158 type 2 diabetics without myocardial ischaemia.

There was no difference in diabetes treatment between patients with or without CAD. Among CAD patients, the prevalence of the metabolic syndrome was not different in those with normal ECG and those with ECG abnormalities. Gender, age, diabetes duration, hypertension, family history of CAD, smoking, microalbu-minuria, HbA1c, body mass index, cholesterol, triglycerides, LDL-C, HDL-C, metabolic syndrome and autonomic dysfunction were analysed as predictors of asymptomatic CAD using a multiple logistic regression analysis. Microalbuminuria, hypercholesterolaemia, smoking, metabolic syndrome, and family history of CAD were predictors of silent CAD (Table I).

Among NCEP criteria, only HDL levels were associated with silent CAD (OR: 2.04; 95% CI:1.23-1.38; P=0.005).
In patients treated with diet alone or oral agents, the multiple logistic regression analysis showed that HOMA, microalbuminuria, hypercholesterolaemia, and smoking were predictors of silent CAD (Table II).

These data show that the metabolic syndrome and insulin resistance are independently associated with the presence of silent coronary artery disease in patients with uncomplicated type 2 diabetes.