title: Does coronary Atherosclerosis Deserve to be Diagnosed earlY in Diabetic patients? The DADDY-D trial. Screening diabetic patients for unknown coronary disease.
abstract: OBJECTIVE
  To evaluate if screening and treatment of asymptomatic coronary artery disease (CAD) are effective in preventing first cardiac event in diabetics.
  
  
  METHODS
  Diabetic patients without known CAD were randomly assigned to undergo a screening for silent myocardial ischemia followed by revascularization or to continue follow-up. The reduction of cardiac death (CD) or nonfatal myocardial infarction (MI) represented the primary aim; secondary aim was the prevention of heart failure (HF).
  
  
  RESULTS
  From September 2007 to May 2012, 520 patients (62 years; 104 female) were enrolled. Silent CAD was found in 20 of 262 patients (7.6%), revascularization was performed in 12 (4.6%). After a mean follow-up of 3.6 years 12 events (4.6%) occurred in the study group and 14 (5.4%) in the follow-up (HR=0.849, 95% CI: 0.393-1.827, P=0.678). The occurrence of first HF episode did not differ between groups: 2 (0.8%) in screened and 7 (2.7%) in follow-up (HR=0.273, 95% CI: 0.057-1.314, P=0.083). Subgroup analysis revealed a significantly lower HF episodes among patients with intermediate cardiovascular risk (Log rank P=0.022). Additionally, when CD and MI were analysed within subgroups, a significant lower number of CDs was observed among older than 60 years (P=0.044).
  
  
  CONCLUSIONS
  Screening and revascularization of silent CAD in diabetics, failed to demonstrate a significant reduction in cardiac events and HF episodes. However, our data indicate that further research is warranted in patients older than 60 years and those with an intermediate cardiovascular risk. CLINICALTRIALS.GOV: NCT00547872.
authors.affiliation: Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy. Electronic address: f.turrini@ausl.mo.it.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Turrini
authors.affiliation: Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Scarlini
authors.affiliation: Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Mannucci
authors.affiliation: Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Messora
authors.affiliation: Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Giovanardi
authors.affiliation: Cardiology Clinic, Department of Cardiovascular Disease, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Magnavacchi
authors.affiliation: Cardiology Clinic, Department of Cardiovascular Disease, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cappelli
authors.affiliation: Geriatrics Clinic, Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, University of Modena, Via Giardini 1355, 41125 Modena, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Evandri
authors.affiliation: Geriatrics Clinic, Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, University of Modena, Via Giardini 1355, 41125 Modena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zanasi
authors.affiliation: Diabetology Service, AUSL Modena, Via del Pozzo 71, 41124 Modena, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Romano
authors.affiliation: Diabetology Service, AUSL Modena, Via del Pozzo 71, 41124 Modena, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Cavani
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hesperia Hospital, Modena, Via Arquà 80, 41125 Modena, Italy.
authors.forename: Italo
authors.initials: I
authors.lastname: Ghidoni
authors.affiliation: Cardiology Clinic, Department of Cardiovascular Disease, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tondi
authors.affiliation: Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bondi
mesh_terms: D058070:Asymptomatic Diseases; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D003643:Death; D003925:Diabetic Angiopathies / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control
keywords: Diabetes mellitus; Exercise tolerance testing; Revascularization; Screening; Silent myocardial ischemia