To explore the prevalence and risk factors of silent myocardial ischemia (SMI) detected by using single photon emission computed tomography (SPECT) in Chinese asymptomatic patients with type 2 diabetes (T2D). In this hospital-based retrospective study, 821 T2D patients who were screened for SMI detected by stress myocardial perfusion imaging using SPECT between June 2014 and July 2016 were investigated. Clinical indicators were compared between the patients with SMI and controls without SMI. Risk factors for SMI were evaluated by univariate and multivariate analysis. In this study, there were 131 patients with SMI in asymptomatic diabetes and the prevalence of SMI was 21.3% of 614 individuals. Logistic regression analysis indicated that diabetic retinopathy (OR= 1.474, 95% CI: 1.113-1.951, P=.007), male gender (OR= 1.805, 95% CI: 1.183-2.747, P=.006), and low-density lipoprotein (LDL) cholesterol (OR= 1.298, 95% CI: 1.042-1.615, P=.02) were risk factors associated with SMI. Besides, the prevalence of SMI increased in associated with the progression of retinopathy (P=.041). The percentage of SMI diagnosed in patients with no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) were 18.5% (75/405), 25.2% (37/147), and 30.6% (19/62), respectively. The percentage of SMI in male (24.5%, 85/347) was higher than that in female (17.2%, 46/267), P=.029. Physicians should be aware of these conditions when examining male patients with type 2 diabetes, especially with DR and/or high level of low-density lipoprotein cholesterol (LDL cholesterol), even if otherwise asymptomatic. A routine screening for SMI may thus be considered advisable in these patients.