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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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Standards of Medical Care in Diabetes—2012
TL;DR: These standards of care are intended to provide clinicians, patients, researchers, payers, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care.
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2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology.
Gilles Montalescot,Udo Sechtem,Stephan Achenbach,Felicita Andreotti,Chris Arden,Andrzej Budaj,Raffaele Bugiardini,Filippo Crea,Thomas Cuisset,Carlo Di Mario,J. Rafael Ferreira,Bernard J. Gersh,Anselm K. Gitt,Jean-Sébastien Hulot,Nikolaus Marx,Lionel H. Opie,Matthias Pfisterer,Eva Prescott,Frank Ruschitzka,Manel Sabaté,Roxy Senior,David P. Taggart,Ernst E. van der Wall,Christiaan J. Vrints,José Luis Zamorano,Helmut Baumgartner,Jeroen J. Bax,Héctor Bueno,Veronica Dean,Christi Deaton,Çetin Erol,Robert Fagard,Roberto Ferrari,David Hasdai,Arno W. Hoes,Paulus Kirchhof,Juhani Knuuti,Philippe Kolh,Patrizio Lancellotti,Aleš Linhart,Petros Nihoyannopoulos,Massimo F Piepoli,Piotr Ponikowski,Per Anton Sirnes,Juan Tamargo,Michal Tendera,Adam Torbicki,William Wijns,Stephan Windecker,Marco Valgimigli,Marc J. Claeys,Norbert Donner-Banzhoff,Herbert Frank,Christian Funck-Brentano,Oliver Gaemperli,José Ramón González-Juanatey,Michalis Hamilos,Steen Husted,Stefan James,Kari Kervinen,Steen Dalby Kristensen,Aldo P. Maggioni,Axel R. Pries,Francesco Romeo,Lars Rydén,Maarten L. Simoons,Ph. Gabriel Steg,Adam Timmis,Aylin Yildirir +68 more
TL;DR: The If Inhibitor Ivabradine in Patients With Coronary Artery Disease and Left Ventricular Dysfunction is evaluated as well as patients with Diabetes mellitus for Optimal management of Multivessel disease.
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Standards of Medical Care in Diabetes—2010
TL;DR: These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care.
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2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Philip Greenland,Joseph S. Alpert,George A. Beller,Emelia J. Benjamin,Matthew J. Budoff,Zahi A. Fayad,Elyse Foster,Mark A. Hlatky,John McB. Hodgson,Frederick G. Kushner,Michael S. Lauer,Leslee J. Shaw,Sidney C. Smith,Allen J. Taylor,William S. Weintraub,Nanette K. Wenger +15 more
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Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement.
Sheri R. Colberg,Ronald J. Sigal,Bo Fernhall,Judith G. Regensteiner,Bryan Blissmer,Richard R. Rubin,Lisa Chasan-Taber,Ann L. Albright,Barry Braun +8 more
TL;DR: The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.
References
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Journal ArticleDOI
Noninvasive screening for coronary atherosclerosis and silent ischemia in asymptomatic type 2 diabetic patients: is it appropriate and cost-effective?
TL;DR: Computed tomography coronary calcium scanning could be the first noninvasive screening test in these clinically high-risk diabetic patients, followed by stress MPI to detect silent ischemia in those who exhibit high coronary calcium scores.
Journal ArticleDOI
Screen Testing: Cardiovascular Prevention in Asymptomatic Diabetic Patients
TL;DR: This analysis shows that unconditional treatment is the dominant strategy, costing 24% less ($3.2 billion) and preventing 25% more atherosclerotic events annually on a national basis.
Journal ArticleDOI
Screening for Coronary Artery Disease in Patients With Diabetes
TL;DR: The variety of diagnostic exams available for the identification of CAD in patients with diabetes are explained and will assist health care providers in determining the appropriate diagnostic tool for each patient.
Journal ArticleDOI
Asymptomatic patients with diabetes mellitus should not be screened for coronary artery disease.
TL;DR: The opponent in this debate, Dr Frans Wackers, has a very distinguished career in nuclear cardiology and learned a great deal from during his collaboration on sestamibi, which formed basis for the subsequent success of the nuclear iology laboratory effort in this area.
Journal ArticleDOI
The changing costs and benefits of screening for asymptomatic coronary heart disease in patients with diabetes
TL;DR: The recent research suggesting that there may be substantial numbers of high-risk asymptomatic patients who have diabetes with undiagnosed CHD and who could benefit from more-active intervention is identified, however, current guidelines strongly discourage this practice, except in limited clinical situations, such as before major surgery.
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