Screening for coronary heart disease in patients with diabetes mellitus
- Jeroen J Bax, MD, PhD
Jeroen J Bax, MD, PhD
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Cardiology
- Leiden University Medical Center, The Netherlands
- Frans J Th Wackers, MD, PhD
Frans J Th Wackers, MD, PhD
- Professor Emeritus of Diagnostic Radiology and Medicine
- Yale University School of Medicine
- Victoria Delgado, MD, PhD
Victoria Delgado, MD, PhD
- Cardiologist; Department of Cardiology
- Leiden University Medical Center
- Section Editors
- David M Nathan, MD
David M Nathan, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- Harvard Medical School
- Patricia A Pellikka, MD, FACC, FAHA, FASE
Patricia A Pellikka, MD, FACC, FAHA, FASE
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine
- Mayo Clinic College of Medicine
Diabetes mellitus is associated with an approximately twofold increased risk of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD) mortality, as shown in a meta-analysis of 102 prospective studies including 698,782 individuals (hazard ratio 2.0; 95% CI 1.8-2.2) . Diabetes frequently coexists with other cardiovascular risk factors such as hypertension and dyslipidemia, sometimes known as the metabolic or cardiometabolic syndrome. However, diabetes mellitus confers an increased risk for cardiovascular events independent of other traditional risk factors . (See "Risk factors for type 2 diabetes mellitus", section on 'Lifetime risk/prevalence'.)
Patients with diabetes and noncoronary atherosclerotic disease have a higher risk of CHD than patients with diabetes but no known vascular disease and thus require a different diagnostic approach. Such patients should have appropriate aggressive individualized diagnostic workup. (See "Overview of the risk equivalents and established risk factors for cardiovascular disease", section on 'Noncoronary atherosclerotic disease' and "Outpatient evaluation of the adult with chest pain".)
In nearly all patients with diabetes, the results of screening will generally not change medical therapy, since aggressive preventive measures, such as control of blood pressure and lipids, would already be indicated. However, the use of low-dose aspirin may not be warranted in all asymptomatic diabetic patients, since >30 percent of asymptomatic diabetic patients may not have CHD and the use of coronary artery calcium (CAC) score could be considered as a measure to detect/exclude CHD. (See 'Screening issues' below and 'Computed tomography' below.)
Issues related to the detection of coronary atherosclerosis and ischemia, as well as the studies related to screening for CHD in patients with diabetes, will be reviewed here. The epidemiology of CHD in patients with diabetes and the data related to screening for CHD in the general population are discussed separately. (See "Prevalence of and risk factors for coronary heart disease in diabetes mellitus" and "Screening for coronary heart disease".)
Whether the patient suffers from type 1 or type 2 diabetes, along with the patient's age and duration of time living with diabetes, will impact the risk for developing cardiovascular disease (CVD), as diabetes itself is a powerful risk factor for the future development of CVD. In patients with type 1 diabetes, CVD becomes the leading cause of death after 10 years of duration and accounts for 40 percent of all deaths after 20 years of duration . Most studies on cardiovascular risk in patients with diabetes have been performed in patients with type 2 diabetes, who are typically older at disease onset than those with type 1 diabetes.
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- PREVALENCE OF ASYMPTOMATIC CHD
- Computed tomography
- Stress testing
- SCREENING ISSUES
- Purpose of screening
- Screening tests for CHD diagnosis
- Screening tests for CHD prognosis
- - Low-risk stress tests
- - CAC scanning
- - CT angiography
- DOES SCREENING FOR SUBCLINICAL CHD IMPROVE OUTCOMES?
- ROLE OF RISK ENGINES TO DEFINE CV RISK
- RECOMMENDATIONS OF PROFESSIONAL SOCIETIES
- SUMMARY AND RECOMMENDATIONS