Open Access
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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Journal ArticleDOI
Screening for coronary artery disease in diabetic patients: A commentary
Daniel S. Berman,Daniel S. Berman,Alan Rozanski,Jamal S. Rana,Jamal S. Rana,Leslee J. Shaw,Nathan D. Wong,James K. Min +7 more
TL;DR: Diabetes is a major coronary artery disease (CAD) risk factor which is increasing in prevalence, and commonly associated with asymptomatic CAD, and secondary prevention of CAD is recommended for all adult diabetic patients.
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Type 1 diabetes: Developing the first risk-estimation model for predicting silent myocardial ischemia. The potential role of insulin resistance
Gemma Llauradó,Albert Cano,Cristina Hernández,Cristina Hernández,Montserrat González-Sastre,Ato-Antonio Rodríguez,Jordi Puntí,Eugenio Berlanga,Lara Albert,Rafael Simó,Rafael Simó,Joan Vendrell,José-Miguel González Clemente,José-Miguel González Clemente +13 more
TL;DR: This study provides the first ever reported risk-estimation model for predicting silent myocardial ischemia (SMI) in patients with type 1 diabetes and no clinical cardiovascular disease, and includes insulin resistance and active smoking as main predictors of SMI.
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Serial imaging and outcome prediction
TL;DR: More than four decades of experience in nuclear cardiac imaging suggests that ischemic heart disease is a dynamic process, that the course of the disease could be altered by therapy, and that patient survival has improved over the decades, one would expect many more studies based on serial changes on imaging.
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Activité physique et diabète
Ronald J. Sigal,Marni J. Armstrong,Pam Colby,Glen P. Kenny,Ronald C. Plotnikoff,Sonja M. Reichert,Michael C. Riddell +6 more
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Study of Myocardial Perfusion in Obese Individuals without Known Ischemic Heart Disease
TL;DR: The factors associated with abnormal myocardial perfusion in obese patients without known IHD were age, DM, presence of typical angina, ventricular dysfunction, and inability to undergo physical stress as clinical variables, in addition to functional capacity during physical stress.
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.
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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.
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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
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