This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.01.079v1 49/19/1918    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 Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Beller, G. A. Search for Related Content PubMed Articles by Beller, G. A.

VIEWPOINT AND COMMENTARY

Noninvasive Screening for Coronary Atherosclerosis and Silent Ischemia in Asymptomatic Type 2 Diabetic Patients

Is it Appropriate and Cost-Effective?

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.

Manuscript received January 11, 2007; revised manuscript received January 11, 2007, accepted January 15, 2007.

^_* Reprint requests and correspondence: Dr. George A. Beller, Division of Cardiovascular Medicine, University of Virginia Health System, P.O. Box 800158, Charlottesville, Virginia 22908. (Email: GAB4C{at}hscmail.mcc.virginia.edu).

Coronary artery disease (CAD) accounts for 65% to 80% of deaths in diabetic patients. The merits of screening asymptomatic type 2 diabetic patients for either (A) the presence of coronary atherosclerosis by imaging of coronary calcification using cardiac computed tomography or (B) silent ischemia by stress myocardial perfusion imaging (MPI) remain controversial. Some observers have advocated for such noninvasive screening in at least the subset of the diabetic population who have significant clinical CAD risk factors, so that the highest risk patients for future cardiac events can be identified and offered more aggressive intensive medical therapy or coronary revascularization and optimum medical therapy. Computed tomography coronary calcium scanning could be the first noninvasive screening test in these clinically high-risk diabetic patients, followed by stress MPI to detect silent ischemia in those who exhibit high coronary calcium scores.

Abbreviations and Acronyms   CAC = coronary artery calcium   CAD = coronary artery disease   CT = computed tomography   ECG = electrocardiogram   LDL = low-density lipoprotein   MPI = myocardial perfusion imaging   SPECT = single-photon emission computed tomography

This article has been cited by other articles:

				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]

				R. W. Nesto LDL Cholesterol Lowering in Type 2 Diabetes: What Is the Optimum Approach? Clin. Diabetes, January 1, 2008; 26(1): 8 - 13. [Abstract] [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]

				G. A. Diamond and S. Kaul COURAGE Under Fire: On the Management of Stable Coronary Disease J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1604 - 1609. [Abstract] [Full Text] [PDF]