title: Identification of coronary heart disease in asymptomatic individuals with diabetes mellitus: to screen or not to screen.
abstract: Coronary heart disease (CHD) is highly prevalent in patients with diabetes mellitus (DM), and remains the single most common cause of death among this population. Regrettably, a significant percentage of diabetics fail to perceive the classic symptoms associated with myocardial ischemia. Among asymptomatic diabetics, the prevalence of abnormal cardiac testing appears to be high, ranging between 10% and 62%, and mortality is significantly higher in those with abnormal scans. Hence, the potential use of screening for CHD detection among asymptomatic DM individuals is appealing and has been recommended in certain circumstances. However, it was not until recently, that this question was addressed in clinical trials. Two studies randomized a total of 2,023 asymptomatic diabetics to screening or not using cardiac imaging with a mean follow up of 4.4 ± 1.4 years. In combination, both trials showed lower than expected annual event rates, and failed to reduce major cardiovascular events in the screened group compared to the standard of care alone. The results of these trials do not currently support the use of screening tools for CHD detection in asymptomatic DM individuals. However, these studies have important limitations, and potential explanations for their negative results that are discussed in this manuscript.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Washington. Seattle, WA, USA.
authors.forename: Paco E
authors.initials: PE
authors.lastname: Bravo
authors.affiliation: Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington. Seattle, WA, USA.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.affiliation: Noninvasive Cardiovascular Imaging Program. Departments of Radiology and Medicine,. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.affiliation: Division of Cardiology, Department of Medicine, University of Washington. Seattle, WA, USA.
authors.forename: Kelley R
authors.initials: KR
authors.lastname: Branch
mesh_terms: D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016032:Randomized Controlled Trials as Topic
keywords: Screening; coronary heart disease; diabetes