Is silent myocardial infarction more common in women with type 2 diabetes than in men?

Monica C. Stiles, Elizabeth R. Seaquist, Jean Francois Yale, Jennifer B. Green, Lois Anne Katz, Sarah Kempainen, Laney S. Light, Patricia V. Pepper, Zhu Ming Zhang, Elsayed Z. Soliman

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objective: Our aim was to determine if silent myocardial infarction (MI) is more common in women with type 2 diabetes than in men. Our secondary aim was to examine the relationships between silent MI and risk factors for cardiovascular disease. Research design and methods: The Action to Control Cardiovascular Risk in Diabetes (ACCORD) database was used to determine if women had more silent MI on baseline electrocardiograms (ECGs) than did men with a similar unremarkable cardiovascular history. MI was diagnosed using ECG analysis according to the Minnesota code. Multivariable logistic regression analysis was used to compare demographic and clinical associations. Interactive effects of risk factors by gender were tested using a forward selection algorithm. Results: Men were found to have a higher prevalence of silent MI on baseline ECGs than women (6% vs 4%, P =.001). Women had lower odds of silent MI than men after adjusting for other risk factors (OR = 0.80, P =.04). Race and ethnicity were significantly associated with silent MI (P =.02), with Asians having the highest and African Americans and Hispanics having lower odds relative to whites. Conclusions: Our main findings provide no evidence that silent MI, as detected by the Minnesota code, was more common in women than in men in the ACCORD cohort. If, as in the general population, the women in ACCORD are found to have a higher heart disease mortality rate than the men, it seems unlikely that failure to recognize clinically silent heart disease in the years before study enrollment could be a major cause.

Original languageEnglish (US)
Pages (from-to)118-122
Number of pages5
JournalJournal of Diabetes and Its Complications
Issue number2
StatePublished - Mar 2012

Bibliographical note

Funding Information:
Funding: This study was supported by grants from the National Heart, Lung, and Blood Institute ( NO1-HC-95178, NO1-HC-95179, NO1-HC-95180, NO1-HC-95181, NO1-HC-95182, NO1-HC-95183, NO1-HC-95184, IAA-Y1-9035 , and IAA-Y-HC-1010 ), by other components of the National Institutes of Health, including the National Institute of Diabetes and Digestive and Kidney Disease, the National Institute of Aging, and the National Eye Institute , by the C enters for Disease Control and Prevention ; and by the General Clinical Research Centers . The following companies provided study medications, equipment, or supplies: Abbott Laboratories, Amlyn Pharmaceuticals, AstraZeneca, Bayer HealthCare, Closer HealthCare, GlaxoSmithKline, King Pharmaceuticals, Merck, Novartis, Novo Nordisk, Omron Healthcare, Sanofi-Aventis, and Schering-Plough


  • Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial
  • Cardiovascular disease in women
  • Silent myocardial infarction
  • Type 2 diabetes


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