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Objectives: To assess the silent ischemic changes in diabetics presented to a tertiary care hospital and to know its association with different variables. Methodology: A cross sectional study done at Ayub Teaching Hospital (ATH) Abbottabad, from 16th July 2016 to 14th November 2016. Data was collected by filling preformed questionnaire, examining the patients and seeing ECG by interviewers and analyzed using SPSS 23. Results: Our results shows that out of total 246 patients 45.1% were males with mean age of 51.62±11.3 years. Of them 11% were type 1 while 89% were type 2 diabetics. About 129(52.4%) of patients had ischemic changes on ECG,19.6% were smokers, 26.8% had family history of DM, 21(8.5%) of hypertension, 99(40.2%) had family history of both DM and hypertension. Among patients 66.3% had raised HbA1C level, 43.1% had dyslipidemia, 7.3% had proteinurea, 22.7% had glycosuria and 18.7% had both proteinuria and glycosuria. Patients having ischemic changes on ECG, 127 patients aged more than 30 years and regarding duration of diabetes mellitus (DM) 44 had <5years, 47 had 5-10 years, 16 had 10-15years, 17 had 15-20years while 5 had>20years duration of DM. Conclusion: Ischemic changes were positively associated with age of patients, duration of diabetes, hypertension, raised HbA1C level and hyperlipidemia. [ABSTRACT FROM AUTHOR]