Lessons learned from the detection of ischemia in asymptomatic diabetics (DIAD) study

Excerpt

Over 20 million Americans and 200 million people worldwide are estimated to have type 2 diabetes. Cardiovascular disease is the leading cause of death and a major cause of morbidity in diabetic patients, and therefore represents a serious global health care problem. It is well recognized that diabetic patients with symptomatic coronary artery disease are at high risk for adverse cardiac events. However, there is significant concern about cardiovascular risk in others with no known history of heart disease or symptoms of myocardial ischemia. Professional organizations have advocated aggressive primary preventative therapies with statins, aspirin, anti-hypertensives, and glycemic control. However, despite greater utilization of these therapies, patients with diabetes remain at risk for myocardial infarction and sudden cardiac death. Concern for these complications has generated enthusiasm for screening with specialized cardiac testing. The rationale for screening is that the early identification of ischemia or structural CAD would lead to additional therapies, including coronary revascularization, which might prevent myocardial infarction of sudden death. …