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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

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