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Abstract: Objectives: We investigated whether α2-adrenergic receptor (AR) polymorphisms (α2A-AR, α2B-AR and α2C-AR gene) affected silent myocardial ischemia (SMI) in patients with type 2 diabetes mellitus (T2DM). Design and methods: Genetic polymorphisms were determined in 321 patients with T2DM and coronary artery disease (CAD). Among them, 129 patients experienced transient asymptomatic ST-depression during 24-hour ambulatory electrocardiogram (SMI group), and the remaining 192 patients who had ambulatory electrocardiogram-symptom matching angina were categorized as angina group. Results: The genotype distribution and allele frequencies of α2B-AR gene polymorphism (insertion [I]/deletion[D]) exhibited significant difference between SMI group and angina group (both P<0.05), with genotype II (34.9%) being higher in SMI group than in angina group (19.8%)(P<0.01). Multivariable logistic regression analysis revealed that duration of diabetes and genotype II of α2B-AR gene polymorphism were independently associated with SMI. Conclusions: Homozygote for I allele of α2B-AR gene polymorphism is associated with SMI in T2DM patients with CAD. [ABSTRACT FROM AUTHOR]