title: The limited usefulness of the treadmill test or a risk-guided approach in screening for asymptomatic coronary heart disease in Japanese patients with type 2 diabetes.
abstract: OBJECTIVE
  We prospectively investigated the efficacy of the screening methods for asymptomatic coronary heart disease (CHD) in Japanese patients with type 2 diabetes using the treadmill tolerance test (TTT) as a first-line test or the American Diabetes Association (ADA) guidelines.
  
  
  METHODS
  The subjects included consecutive inpatients with type 2 diabetes (n=331) assessed with both electrocardiogram (ECG) at rest and TTT. Subjects with abnormal TTT findings were evaluated using stress myocardial perfusion scintigraphy (MPS).
  
  
  RESULTS
  A total of 60 out of 69 subjects with positive TTT findings underwent MPS, among whom a total of 22 subjects (6.6% of the total number of subjects) had positive MPS results. Among those with positive MPS results, a total of 14 subjects underwent coronary angiography, eight of whom were determined to have significant coronary artery stenosis. The prevalence rates of hypertension and micro/macroalbuminuria were significantly higher in the MPS-positive group (77.3% and 54.5%, respectively) than in the TTT-negative group (44.7% and 27.1%, respectively). Among the subjects with positive MPS results, 68.2% met the 1998 ADA criteria.
  
  
  CONCLUSIONS
  Neither the TTT as a first-line test nor the ADA guidelines are sufficiently adequate screening methods to detect asymptomatic CHD in Japanese subjects with type 2 diabetes. Conducting routine screening for asymptomatic CHD in Japanese patients with type 2 diabetes may therefore not be very useful.
authors.affiliation: Center for Diabetes & Endocrinology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Japan. yk-kawasaki@kitano-hp.or.jp
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kawasaki-Ogita
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hamamoto
authors.forename: Sachiko
authors.initials: S
authors.lastname: Honjo
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeda
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Wada
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nomura
authors.forename: Yorihiro
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Ryuji
authors.initials: R
authors.lastname: Nohara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koshiyama
mesh_terms: D044466:Asian People; D058070:Asymptomatic Diseases; D003327:Coronary Disease / Q000175:diagnosis* / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000209:etiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment