Type 2 diabetes mellitus (T2DM) is a major metabolic disorder associated with a markedly increased risk of cardiovascular complications. Subclinical myocardial ischemia frequently develops in patients with T2DM without overt clinical symptoms, remaining undetected for prolonged periods and contributing to adverse cardiovascular outcomes. This article examines the clinical significance of early detection and assessment of subclinical myocardial ischemia in patients with T2DM, with particular emphasis on underlying microvascular dysfunction, endothelial impairment, and autonomic neuropathy. The role of non-invasive diagnostic methods, including electrocardiographic monitoring and advanced echocardiographic techniques, is highlighted as essential for timely risk stratification and prevention of disease progression. Understanding the mechanisms and clinical implications of subclinical myocardial ischemia may improve cardiovascular risk management and long-term prognosis in patients with T2DM.

type 2 diabetes mellitus, subclinical myocardial ischemia, silent ischemia, endothelial dysfunction, cardiovascular risk assessment

American Diabetes Association. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes. Diabetes Care. 2023;46(Suppl.1):S158–S190.

Marwick T.H., Ritchie R., Shaw J.E., Kaye D. Implications of Underlying Mechanisms for the Recognition and Management of Diabetic Cardiomyopathy. Journal of the American College of Cardiology. 2018;71(3):339–351.

Cosentino F., Grant P.J., Aboyans V. et al. 2019 ESC Guidelines on Diabetes, Pre-diabetes, and Cardiovascular Diseases. European Heart Journal. 2020;41(2):255–323.

Crea F., Camici P.G., Bairey Merz C.N. Coronary Microvascular Dysfunction: An Update. European Heart Journal. 2014;35(17):1101–1111.

Raggi P., Shaw L.J., Berman D.S., Callister T.Q. Prognostic Value of Coronary Artery Calcium Screening in Subjects With and Without Diabetes. Journal of the American College of Cardiology. 2004;43(9):1663–1669.

Holland D.J., Marwick T.H., Haluska B.A. Subclinical Left Ventricular Dysfunction and Silent Ischemia in Diabetes Mellitus. Heart. 2012;98(7):551–556.

Jo’rayeva, G. (2024). Combination of Diabetes and Metabolic Syndrome. Modern Science and Research, 3(12), 691–696.

Jo’rayeva, G. (2025). Risk Factors for the Development of Climacteric Disorders in Women with the Metabolic Syndrome. Modern Science and Research, 4(1), 1090–1092.

Jo’rayeva, G. (2025). The Role of Thyroid Hormones in Child Development. Modern Science and Research, 4(2), 990–995.

Jo’rayeva, G. (2025). Calcium Metabolism and Osteoporosis: The Role of the Endocrine System. Modern Science and Research, 4(3), 1155–1159.

Jo’rayeva, G. (2025). Strategies for Preventing Macro- and Microangiopathic Complications of Diabetes Mellitus. Modern Science and Research, 4(4), 1884–1892.