This Article Full Text Full Text (PDF) All Versions of this Article: j.jacc.2006.09.057v1 49/19/1915    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Diamond, G. A. Articles by Shah, P. K. Search for Related Content PubMed PubMed Citation Articles by Diamond, G. A. Articles by Shah, P. K. Related Collections Related Article

VIEWPOINT AND COMMENTARY

Screen Testing

Cardiovascular Prevention in Asymptomatic Diabetic Patients

Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California; and the David Geffen School of Medicine, University of California, Los Angeles, California.

Manuscript received July 28, 2006; revised manuscript received September 12, 2006, accepted September 19, 2006.

^_* Reprint requests and correspondence: Dr. George A. Diamond, 2408 Wild Oak Drive, Los Angeles, California 90068. (Email: gadiamond{at}pol.net).

It has recently been proposed that asymptomatic diabetic patients undergo routine screening for subclinical atherosclerotic disease using myocardial perfusion scintigraphy. We herein analyze the expected cost and benefit associated with such a conditional test-treatment strategy (scintigraphic testing followed by statin treatment in positive test responders) in comparison to an unconditional treatment strategy (no testing and statin treatment in all). This analysis shows that unconditional treatment is the dominant strategy, costing 24% less ($3.2 billion) and preventing 25% more (16,800) atherosclerotic events annually on a national basis.

Abbreviations and Acronyms   CV = cardiovascular   MPS = myocardial perfusion scintigraphy

Related Article

Noninvasive Screening for Coronary Atherosclerosis and Silent Ischemia in Asymptomatic Type 2 Diabetic Patients: Is it Appropriate and Cost-Effective?

George A. Beller
J. Am. Coll. Cardiol. 2007 49: 1918-1923. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				R. J. Gibbons and T. C. Gerber Calcium Scoring With Computed Tomography: What Is the Radiation Risk? Arch Intern Med, July 13, 2009; 169(13): 1185 - 1187. [Full Text] [PDF]

				L. H. Young, F. J. Th. Wackers, D. A. Chyun, J. A. Davey, E. J. Barrett, R. Taillefer, G. V. Heller, A. E. Iskandrian, S. D. Wittlin, N. Filipchuk, et al. Cardiac Outcomes After Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes: The DIAD Study: A Randomized Controlled Trial JAMA, April 15, 2009; 301(15): 1547 - 1555. [Abstract] [Full Text] [PDF]

				R. J. Gibbons, P. A. Araoz, and E. E. Williamson The Year in Cardiac Imaging J. Am. Coll. Cardiol., January 6, 2009; 53(1): 54 - 70. [Full Text] [PDF]

				A. Avignon, A. Sultan, C. Piot, D. Mariano-Goulart, J.-F. Thuan dit Dieudonne, J. P. Cristol, and A. M. Dupuy Osteoprotegerin: A Novel Independent Marker for Silent Myocardial Ischemia in Asymptomatic Diabetic Patients Diabetes Care, November 1, 2007; 30(11): 2934 - 2939. [Abstract] [Full Text] [PDF]

				J. J. Bax, L. H. Young, R. L. Frye, R. O. Bonow, H. O. Steinberg, and E. J. Barrett Screening for Coronary Artery Disease in Patients With Diabetes Diabetes Care, October 1, 2007; 30(10): 2729 - 2736. [Abstract] [Full Text] [PDF]

				A. Boyar Cardiovascular Prevention in Asymptomatic Diabetic Patients J. Am. Coll. Cardiol., September 18, 2007; 50(12): 1203 - 1203. [Full Text] [PDF]

				G. A. Diamond, S. Kaul, and P. K. Shah Reply J. Am. Coll. Cardiol., September 18, 2007; 50(12): 1204 - 1204. [Full Text] [PDF]

				P. F. Cohn A new look at benefits of drug therapy in silent myocardial ischaemia Eur. Heart J., September 1, 2007; 28(17): 2053 - 2054. [Full Text] [PDF]

				G. A. Beller Noninvasive Screening for Coronary Atherosclerosis and Silent Ischemia in Asymptomatic Type 2 Diabetic Patients: Is it Appropriate and Cost-Effective? J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1918 - 1923. [Abstract] [Full Text] [PDF]