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Cardiac Outcomes After Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes
Lawrence H. Young,J Frans,Deborah Chyun,Janice A. Davey,Eugene J. Barrett,Raymond Taillefer,Gary V. Heller,Ami E. Iskandrian,Steven D. Wittlin,Neil Filipchuk,Robert E. Ratner,Silvio E. Inzucchi +11 more
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TLDR
The Detection of Ischemia in Asymptomatic Diabetics (DIAD) study as discussed by the authors was a randomized controlled trial in which 1123 patients with type 2 diabetes and no symptoms of coronary artery disease were randomly assigned to be screened with adenosine-stress radionuclide myocardial perfusion imaging (MPI) or not.Abstract:
CONTEXT
Coronary artery disease (CAD) is the major cause of mortality and morbidity in patients with type 2 diabetes. But the utility of screening patients with type 2 diabetes for asymptomatic CAD is controversial.
OBJECTIVE
To assess whether routine screening for CAD identifies patients with type 2 diabetes as being at high cardiac risk and whether it affects their cardiac outcomes.
DESIGN, SETTING, AND PATIENTS
The Detection of Ischemia in Asymptomatic Diabetics (DIAD) study is a randomized controlled trial in which 1123 participants with type 2 diabetes and no symptoms of CAD were randomly assigned to be screened with adenosine-stress radionuclide myocardial perfusion imaging (MPI) or not to be screened. Participants were recruited from diabetes clinics and practices and prospectively followed up from August 2000 to September 2007.
MAIN OUTCOME MEASURE
Cardiac death or nonfatal myocardial infarction (MI).
RESULTS
The cumulative cardiac event rate was 2.9% over a mean (SD) follow-up of 4.8 (0.9) years for an average of 0.6% per year. Seven nonfatal MIs and 8 cardiac deaths (2.7%) occurred among the screened group and 10 nonfatal MIs and 7 cardiac deaths (3.0%) among the not-screened group (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.44-1.88; P = .73). Of those in the screened group, 409 participants with normal results and 50 with small MPI defects had lower event rates than the 33 with moderate or large MPI defects; 0.4% per year vs 2.4% per year (HR, 6.3; 95% CI, 1.9-20.1; P = .001). Nevertheless, the positive predictive value of having moderate or large MPI defects was only 12%. The overall rate of coronary revascularization was low in both groups: 31 (5.5%) in the screened group and 44 (7.8%) in the unscreened group (HR, 0.71; 95% CI, 0.45-1.1; P = .14). During the course of study there was a significant and equivalent increase in primary medical prevention in both groups.
CONCLUSION
In this contemporary study population of patients with diabetes, the cardiac event rates were low and were not significantly reduced by MPI screening for myocardial ischemia over 4.8 years.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT00769275.read more
Citations
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Dissertation
Assessment of subclinical cardiac changes in structure and function by cardiovascular magnetic resonance
TL;DR: CMR is able to detect subclinical change in both tissue characteristics and function of the heart and can aid the early and appropriate diagnosis of disease and identify those at the highest risk of adverse outcomes.
Book ChapterDOI
Diabetic Autonomic Neuropathy
TL;DR: In this article, the Ewing tests are used for the assessment of CAN and the presence of CAN is associated with increased cardiovascular mortality, and the main clinical manifestations of DAN result from involvement of cardiac, gastrointestinal, and urogenital systems.
Journal ArticleDOI
Effectiveness of Biomarkers in Cardiology
TL;DR: Dealing coronary heart disease using biomarkers in asymptomatic patients may be the best diagnostic tool for not modifying the clinical conduct to benefit the patient because strategies to control risk factors are well targeted on the basis of overall risk assessment of the individual.
Journal ArticleDOI
Improving cardiovascular disease screening for patients with diabetes
TL;DR: Improving cardiovascular disease screening for patients with diabetes by improving cardiovascular disease detection and prevention in women with diabetes.
References
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Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030
TL;DR: Findings indicate that the "diabetes epidemic" will continue even if levels of obesity remain constant, and given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.
Journal ArticleDOI
Mortality from Coronary Heart Disease in Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior Myocardial Infarction
TL;DR: It is suggested that diabetic patients without previous myocardial infarction have as high a risk of myocardia infarctions as nondiabetic patients with previous my Cardiac Arrest.
Effects of Intensive Glucose Lowering in Type 2 Diabetes The Action to Control Cardiovascular Risk in Diabetes Study Group
TL;DR: The use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events and identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes.
Journal ArticleDOI
Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes
Peter Gæde,P. Vedel,Nicolai Larsen,Nicolai Larsen,Jensen G,Hans-Henrik Parving,Hans-Henrik Parving,Oluf Pedersen,Oluf Pedersen +8 more
TL;DR: A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and microvascular events by about 50 percent.
Journal ArticleDOI
Diabetes and cardiovascular disease : A statement for healthcare professionals from the American heart association
Scott M. Grundy,Ivor J. Benjamin,Gregory L. Burke,Alan Chait,Robert H. Eckel,Barbara V. Howard,William E. Mitch,Sidney C. Smith,James R. Sowers +8 more
TL;DR: The most prevalent form of diabetes mellitus is type 2 diabetes as discussed by the authors, which typically makes its appearance later in life and is associated with other cardiovascular risk factors: dyslipidemia, hypertension, and prothrombotic factors.
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