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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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Stress imaging in patients with diabetes; routine practice?
TL;DR: In diabetic patients with known or suspected coronary artery disease, presence of viability and severe ischemia during dobutamine-stress echocardiography are independently associated with a higher occurrence of hard cardiac events.
Journal ArticleDOI
Coronary Computed Tomography Angiography for Screening in Patients with Diabetes: Can Enhanced Detection of Subclinical Coronary Atherosclerosis Improve Outcome?
TL;DR: This article sought primarily to review the results of studies designed to evaluate a possible role of coronary computed tomography angiography (CCTA) in the screening of asymptomatic diabetic patients for possible obstructive coronary artery disease (CAD).
Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality
Jason J. Sico,Fitsum Baye,Laura J. Myers,John Concato,Jared Ferguson,Eric M. Cheng,Farid Jadbabaie,Zhangsheng Yu,Gregory Arling,Alan J. Zillich,Mathew J. Reeves,Linda S. Williams,Dawn M. Bravata +12 more
TL;DR: In this article, the authors found that the use of stress testing was not associated with a reduced 1-year mortality in patients with cerebrovascular disease with high risk for coronary heart disease.
Impact of atherosclerosis detection by carotid ultrasound on physician behavior and risk-factor management in asymptomatic hypertensive subjects.
Sung Jin Hong,Hyuk Jae Chang,Kijun Song,Geu Ru Hong,Seung Woo Park,Hyun Jae Kang,Eung Ju Kim,Dong-Soo Kim,Myung Ho Jeong +8 more
TL;DR: There are limited data regarding the impact of atherosclerosis detection by carotid ultrasound (CUS) on physician prevention efforts and risk‐factor management for cardiovascular disease.
Book ChapterDOI
Detection of Silent Ischemia in Patients with Type 2 Diabetes
TL;DR: Silent myocardial ischemia is common in diabetic patients and may delay or mask the diagnosis of coronary artery disease, particularly in its early stages.
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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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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