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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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Journal ArticleDOI
Evolution of silent myocardial ischaemia prevalence and cardiovascular disease risk factor management in Type 2 diabetes over a 10-year period: an observational study
Ariane Sultan,Ariane Sultan,F. Perriard,Valérie Macioce,Denis Mariano-Goulart,Catherine Boegner,Jean-Pierre Daurès,Antoine Avignon,Antoine Avignon +8 more
TL;DR: To assess the evolution of silent myocardial ischaemia prevalence and of cardiovascular disease risk factor management over 10 years in people with Type 2 diabetes, a large number of subjects were diagnosed with type 2 diabetes.
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Screening asymptomatic patients with diabetes for unknown coronary artery disease: Does it reduce risk? An open-label randomized trial comparing a strategy based on exercise testing aimed at revascularization with management based on pharmacological/behavioural treatment of traditional risk factors. DADDY-D Trial (Does coronary Atherosclerosis Deserve to be Diagnosed and treated early in Diabetics?)
Fabrizio Turrini,Roberto Messora,Paolo Giovanardi,Stefano Tondi,Paolo Magnavacchi,Rita Cavani,Giandomenico Tosoni,Carlo Cappelli,Elisa Pellegrini,Stefania Romano,Augusto Baldini,Romeo Giulietto Zennaro,Marco Bondi +12 more
TL;DR: In this article, a cohort of diabetic patients without any symptoms and without known coronary artery disease will be screened at two diabetes outpatients services and those with intermediate or high risk (equal or greater than 10% according to the Italian risk chart) will be asked to participate and enrolled.
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Integrating Biomarkers and Imaging for Cardiovascular Disease Risk Assessment in Diabetes
David M. Tehrani,Nathan D. Wong +1 more
TL;DR: The addition of these CVD risk assessment modalities could play an important role for deciding how aggressive a physician should be with pharmacological therapy.
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Atherosclerosis imaging to refine cardiovascular risk assessment in diabetic patients: Computed tomography and positron emission tomography applications.
TL;DR: Two imaging tools that provide anatomical and functional information on pre-clinical coronary atherosclerosis: computed tomography for calcium scoring, and plaque characterization and myocardial ischemia detection and positron emission tomography using tracers to identify functionally unstable plaques are discussed.
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Cardiovascular Disease Risk Assessment: Review of Established and Newer Modalities
David M. Tehrani,Nathan D. Wong +1 more
TL;DR: Many of the current recommendations of CVD risk assessment including those included and excluded from recent guidelines are discussed, while addressing the most recent data supporting renewed and newer modalities for CVDrisk assessment.
References
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