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Diabetes is a major risk factor for ischaemic heart disease; the relative risk increases at least twofold among diabetic men and even more so for women.1 Diabetes is associated with more extensive coronary artery disease and an increased risk of cardiac death.2 Even in the absence of frank diabetes, glucose intolerance has been associated with a heightened risk of coronary artery disease independent of age, blood pressure, and other risk factors.3 Moreover, patients with diabetes are more likely to sustain an acute myocardial infarction,4 and in these patients diabetes is a major independent predictor of morbidity and mortality.5
Because the prevalence of coronary artery disease is higher in diabetic than non-diabetic populations, the probability of disease in the diabetic patient with typical angina is also high. In most cases, this allows a confident clinical diagnosis to be made without the need for non-invasive testing. In many diabetic patients, however, angina is atypical, presenting the physician with a more difficult diagnostic task.
It is clear that when chest pain is atypical the probability of coronary disease will be lower, but will remain appreciably higher in diabetic than non-diabetic patients with similar …
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