Supplementary Table 1 Studies of silent myocardial ischemia and angiographic coronary heart disease in asymptomatic subjects with diabetes.

Reference (year), N / Average [AU: OK?yes] age, DM type / Patient selection / Tests performed / Prevalence of SMI / Proportion of SMI +ve subjects with angio +ve -CHD / Proportion of total with angio +ve -CHD / Proportion of total with TVD or LMS
Koistinen22 (1990),
N = 136 / 46, T2D / Exclusion: Age >60 years, DM duration <5 yrs, serum creatinine >200 mmol/l, lipid therapy, or proliferative retinopathy / ETT, Ex-MPI and 24-h ECG / 40 out of 136 (29%) / 12 out of 34 (35%) / 12 out of 136 (9%) / 2 out of 136 (1.5%)
Naka et al.26 (1992),
N = 142 / 61, T2D / Exclusion: abnormal rest ECG.
Note: The authors reported on only those who achieved target heart rate—data presented here are on all subjects / ETT / 41 out of 142 (29%) / 14 out of 36 (39%) / 14 out of 142 (10%) / Not stated
Paillole et al.27 (1992),
N = 44 / 49, T1D or T2D / Inclusion: diabetes for >10 years, and ≥1 CHD risk factor / ETT, 24-h ECG and Dip-MPI / 9 out of 44 (20%) / 6 out of 9 (67%) / 6 out of 44 (14%) / 5 out of 44 (11%)
Earle et al.29 (1996),
N = 64 / 41, T1D / 50% had microalbuminuria (Group A)
50% had normoalbuminuric (Group B)
none was taking lipid lowering therapy / DSE, ETT / Group A: 8 out of 32 (25%)
Group B: 2/32 (6%) / Group A: 3 out of 4 (75%)
Group B: 1 out of 2 (50%) / Group A: 3 out of 32 (9%)
Group B: 1 out of 32 (3%) / Group A: 1 out of 32 (3%)
Group B: 0 out of 32 (0%)
Valensi et al.32 (1997),
N=92 / 54, T1D or T2D / Inclusion: ≥2 additional CHD risk factors / ETT, Dip-MPI, 48-hr ECG / All: 28 out of 92 (30%)
ETT: 17 out of 92 (18%)
Dip-MPI: 11 out of 92 (12%),
48-h ECG 5 out of 92 (5%) / 9 out of 24 (38%) / 9 out of 92 (10%) / Not stated
Griffin et al.33 (1998)
N = 18 / 38, T1D / Inclusion: T1D for >15 years, proteinuria for >5 years Exclusion: peripheral vascular disease / DSE / 7 out of 18 (39%) / 2 out of 7 (29%) / 2 out of 18 (11%) / 2 out of 18 (11%)
Gaddi et al.5 (1999),
N = 50 / 55, T2D / At least 22% had albuminuria. Those with positive Ex-MPI had DipSE / Ex-MPI, then DipSE / 24 out of 50 (48%) / 13 out of 24 (54%) / 13 out of 50 (26%) / 3 out of 50 (6%)
Janand-Delenne et al.34 (1999),
N = 203 / 42 (for T1D), 61 (for T2D) / Inclusion: long duration of diabetes and ≥1 additional CHD risk factor / ETT and/or Dip-MPI / 32 out of 203 (16%) / 19 out of 32 (59%) / 19 out of 203 (9%) / Probably small— no patient had CABG
Sukhija et al.38 (2000),
N = 30 / NA / Age 35–60 years, all taking either insulin or oral hypoglycemic medication. All had no ECG evidence of MI or ischemia / ETT, 24-h ECG / ETT: 14 out of 30 (47%) 24-h ECG: 14 out of 30 (47%) / 13 out of 14 (93%) / 13 out of 30 (43%) / Not stated
Inoguchi et al.6 (2000),
N = 140 / 68, T2D / All were 60 years of age / ETT ± Dip-MPI (if ETT +ve or unable to exercise) / ETT: 39 out of 140 (28%)
Dip-MPI: 24 out of 93 (26%) / 17 out of 18
(few subjects had angiography) / 17 out of 140 (12%) / 2 out of 140 (1.4%)
Coisne et al.39 (2001),
N = 49 / 61, not stated / All had ≥2 additional CHD risk factors / DSE / 3 out of 49 (9%) / 3 out of 3 (100%) / 3 out of 49 (61%) / Not stated but 2 out of 3 patients had CABG
Penfornis et al.40 (2001),
N = 56 / 60, T1D or T2D / Inclusion: T1D for >15 years or T2D for > 5 years, and ≥3 additional CHD risk factors / Ex-MPI and ETT
or Dip-MPI and DSE / All: 25 out of 6 (45%)
ETT: 5 out of 45 (11%)
MPI: 12 out of 56 (21%)
DSE: 16/56 (29%) / All: 17 out of 26 (65%)
ETT: 3 out of 5 (60%)
MPI: 9 out of 12 (75%)
DSE: 11 out of 16 (69%) / 17 out of 56 (30%) / 6 out of 56 (11%)
Torremocha et al 10 (2001),
N = 72 / 55, T1D or T2D / Inclusion: ≥1 additional CHD risk factor, no ECG evidence of CHD / ETT
Dip-MPI / ETT: 7 out of 72 (10%)
Dip-MPI: 3/72 (4%) / 7 out of 8 (88%) / 7 out of 72 (10%) / 3 out of 72 (4%)
Bacci et al.43 (2002),
N = 56 / 63, T2D / All were unable to exercise and had multiple CHD risk factors / DSE / 5 out of 35 (14%) / 4 out of 5 (80%) / DSE +ve: 4 out of 35 (11%)
Total: 9 out of 35 (54%) b / DSE +ve: 4 out of 35 (11%)
Total: 7 out of 35 (20%) b
Bacci et al.44 (2002),
N = 206 / 58a, T2D / PVD and ≥2 CHD risk factors / ETT / 27 out of 206 (13%)
Only 141 completed a diagnostic test / 20 out of 27 (74%) / 20 out of 206 (10%) / 9 out of 206 (4%)
Larsen et al.46 (2002),
N = 39 / 43, T1D / Duration of diabetes 30 years, HbA1c 8.7%, BMI 25 kg/m2, BP 129/80 mmHg, LDL-cholesterol 3.1 mmol/l; 13% were taking lipid-lowering medication, 18% were taking antihypertensive medication, 26% were current smokers / ETT, IVUS / 6 out of 39 (15%) / NA / 10 out of 39 (26%)b / 3 out of 39 (8%) b
Cosson et al.47 (2003),
N = 362 / 59, 97% had T2D / Normal resting ECG and ≥1 CHD risk factor / Ex-MPI
and/or Dip-MPI / 121 out of 362 (33%) / 44 out of 94 (47%) / 44 out of 362 (12%) / 8 out of 362 (2%)
Gokcel et al.48 (2003),
N = 172 / 54, T2D / Normal resting ECG / MPI / 14 out of 172 (8%) / 13 out of 14 (93%) / 13 out of 172 (8%) / NA
Araz et al.49 (2004),
N = 116 / 53, T2D / Duration of diabetes 5–20 (mean 11) years
45% had macro or microalbuminuria
No diet treated patients / Ex-MPI or Dip-MPI / 18 out of 116 (16%) / 11 out of 17 (65%) / 11 out of 116 (9%) / NA
Cosson et al.50 (2004),
N = 262 / 58, T1D or T2D / Inclusion: T1D >10 years or T2D >5 years, no CHD, normal ECG, one CHD risk factor / ETT
Ex-MPI / ETT: 54 out of 262 (21%)
Ex-MPI: 54 out of 262 (21%) / ETT +ve: 18 out of 54 (33%)
Ex-MPI +ve: 23 out of 54 (43%)a / 34 out of 262 (13%) / 6 out of 262 (2%)
Miller et al.51 (2004),
N = 1738 / 60, NA / Tertiary referral center. Exclusion if symptomatic, prior MI, LBBB or revascularization. Referral bias and possible misclassification of subjects limits this study / Ex- or Phar-MPI / Abnormal: 59%
High risk: 20% / 246 out of 1738 (14%)
All subjects
150 out of 343 (44%
High risk scan / 83% / 30%
Sultan et al.53 (2004),
N = 135 / 52, T1D / Included if either one other CVD risk factor, age ≥60 years or PVD / Dip- and Ex-MPI
Dip and ETT / SPECT: 29 out of 135 (21%)
ETT
7 out of 135 (5%)
Either
30 out of 135 (22%) / 16 out of 24 (67%) / 16 out of 135 (12%) / 1 out of 135 (1%)
Faglia et al.55 (2005),
N = 71 / 62, T2D / Screening (N = 71) arm of intervention study
≥2 CHD risk factors / ETT
DipSE / 15 out of 71 (21%) / 9/14 (64%) / 9 out of 71 (13%) / 4 out of 71 (6%)
Le Feuvre et al.56 (2005),
N = 100 / 62, T2D / Mean duration of diabetes was 14 years. Inclusion: PVD, carotid artery disease or microalbuminuria, or ≥2 additional CHD risk factors. Exclusion: creatinine >250 μmol/l / Ex-MPI and/or Dip-MPI in all
DSE in first 75 subjects / MPI: 62 out of 100 (62%)
DSE: 6 out of 75 (8%)
(possible in 57) / MPI: 26 out of 59 (44%)
DSE: 3 out of 6 (50%) / 26 out of 100 (26%) c / NA
Rajagopalan et al.57 (2005),
N = 1427 / 60, 80% had T2D / Tertiary care referral center. High prevalence of CHD risk factors including obesity / MPI
Ex-, ad-, dip-, dob- / 826 out of 1427 (58%)
High-risk scan 261 out of 1427 (18%) / 78 out of 127 (61%) high-risk scan subjects / 78 out of 1427 (5%)
Only subjects with high risk scans investigated / 106 out of 212 (50%) d
Ramanathan et al.62 (2005),
N = 97 / 47, T1D or T2D / Kidney and kidney-pancreas transplant candidates / Coronary angiography only / 33% of T1D 48% of T2D
Senior et al.58 (2005),
N = 53 / 46, T1D / Islet transplant candidates with normal renal function / ETT
Ex-sesta and/or
Dip-sesta
All subjects had angiography / ETT: 5 out of 53 (9%)
Sesta: 3 out of 53 (6%) / ETT: 4 out of 5 (80%)
Sesa: 1 out of 3 (33%) / 23 out of 53 (43%) / 3 out of 53 (6%)

24- or 48-hr ECG, 24- or 48-hour electrocardiograph; ad, adenosine; angio, coronary angiography; angio-CHD, significant angiographic coronary heart disease; BP, blood pressure; CABG, coronary artery bypass surgery; CHD, coronary heart disease; Dip-MPI, dipyridamole myocardial perfusion imaging; DipSE, dipyridamole stress echocardiography; dob, dobutamine; DM, diabetes mellitus; DSE, dobutamine stress echocardiography; ETT, treadmill or bicycle exercise test; Ex-MPI, exercise myocardial perfusion imaging; FH, family history, HbA1c, glycosylated hemoglobin; IVUS, intravascular ultrasound; LAD, left anterior descending coronary artery; LBBB, left bundle branch block on ECG; LMS, left main stem CHD; MI, acute myocardial infarction, NA, not available/applicable; Phar, pharmacologic stress; PVD, peripheral artery disease; SMI, silent myocardial ischemia; SPECT, single photon emission computed tomography; T1D, type 1 diabetes; T2D, type 2 diabetes; TVD, triple vessel disease. aDerived from data in the original manuscript. bPatients with or without SMI were offered coronary angiography (N =29 agreed). cIncludes subjects with 1 or 2 vessel disease with proximal LAD disease. dApproximate value.