title: Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications.
abstract: Glycemic control alone does not reduce cardiovascular events in patients with type 2 diabetes (T2D), and routine screening of all T2D patients for asymptomatic coronary artery disease (CAD) is not effective for preventing acute cardiac events. We examined the effectiveness of an aggressive screening protocol for asymptomatic CAD in T2D patients with advanced vascular complications.We designed a 3-year cohort study investigating the effectiveness of the aggressive coronary screening for T2D patients with advanced vascular complications and no known coronary events using propensity score adjusted analysis at a national center in Japan. Eligibility criteria included T2D without known coronary events and with any 1 of the following 4 complications: advanced diabetic retinopathy, advanced chronic kidney disease, peripheral artery disease, or cerebrovascular disease. In the aggressive screening group (n = 122), all patients received stress single photon emission computed tomography and those exhibiting myocardial perfusion abnormalities underwent coronary angiography. In the conventional screening group (n = 108), patients were examined for CAD at the discretion of their medical providers. Primary endpoint was composite outcome of cardiovascular death and nonfatal cardiovascular events.Asymptomatic CAD with ≥70% stenosis was detected in 39.3% of patients completing aggressive screening. The proportions achieving revascularization and receiving intensive medical therapy within 90 days after the screening were significantly higher in the aggressive screening group than in the conventional screening group [19.7% vs 0% (P < 0.001) and 48.4% vs 9.3% (P < 0.001), respectively]. The cumulative rate of primary composite outcome was significantly lower in the aggressive screening group according to a propensity score adjusted Cox proportional hazards model (hazard ratio, 0.35; 95% confidence interval, 0.12-0.96; P = 0.04).Aggressive coronary screening for T2D patients with advanced vascular complications reduced cardiovascular death and nonfatal cardiovascular events.
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo Division of General Medicine, Jichi Medical University Graduate School of Medicine, Shimotsuke Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine Department of Public Health/Health Policy, the University of Tokyo Department of Diabetes Research, Diabetes Research Center Department of Nuclear Medicine Department of Cardiovascular Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University School of Medicine Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Tsujimoto
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Yamamoto-Honda
authors.forename: Miyako
authors.initials: M
authors.lastname: Kishimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Noto
authors.forename: Miyako
authors.initials: M
authors.lastname: Morooka
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kubota
authors.forename: Munehiro
authors.initials: M
authors.lastname: Kamimura
authors.forename: Hisao
authors.initials: H
authors.lastname: Hara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kajio
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kakei
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Noda
mesh_terms: D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D015899:Tomography, Emission-Computed, Single-Photon