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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

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