1 Nature clinical practice. Cardiovascular medicine 2005 Vol: 2(10):492-493. DOI: 10.1038/ncpcardio0326

Should patients with type 2 diabetes asymptomatic for coronary artery disease undergo testing for myocardial ischemia?

Mentions
Altmetric
References
  1. Bonow RO and Gheorghiade M (2004) The diabetes epidemic: a national and global crisis. Am J Med 116 (Suppl 5A): 2S-10S , .
    • . . . A marked increase in the incidence of impaired glucose tolerance and the subsequent development of diabetes has resulted in a worldwide health-care crisis.1 The prevalence of type 2 diabetes has increased by more than 61% since 1990,2 due mainly to more-sedentary lifestyles, the ensuing obesity, and the rising age of patients in the US . . .
  2. National Center for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2003 [Link (accessed 15 August 2005) , .
    • . . . A marked increase in the incidence of impaired glucose tolerance and the subsequent development of diabetes has resulted in a worldwide health-care crisis.1 The prevalence of type 2 diabetes has increased by more than 61% since 1990,2 due mainly to more-sedentary lifestyles, the ensuing obesity, and the rising age of patients in the US . . .
  3. National Center for Health Statistics. Prevalence of overweight and obesity among adults: United States, 1999-2002 (results from the 1999-2002 National Health and Nutrition Examination Survey) [Link (accessed 18 August 2005) , .
    • . . . More than 75% of diabetes-related hospitalizations are caused by atherosclerosis and its complications.3 Furthermore, severe proximal and distal coronary artery disease (CAD) and coronary artery plaque alterations, including inflammation and thrombosis, are more-frequently observed on coronary arteriography and intravascular ultrasound in individuals with diabetes than in those without.4 . . .
  4. Levin DC and Fallon JT (1982) Significance of the angiographic morphology of localized coronary stenosis: histopathologic correlations. Circulation 66: 316-320 , .
  5. Vlassara H (1996) Advanced glycosylation end-products and atherosclerosis. Ann Med 28: 419-426 , .
    • . . . Glycemia control lowers the risk of vascular diseases, by reducing the production of advanced glycosylation end-products,5 the accumulation of which is thought to promote atherosclerosis.6 The atherosclerosis-promoting effects of advanced glycosylation end-products are listed in Supplementary Box 1 online . . .
  6. Farkouh ME et al. (2004) Diabetes and cardiovascular disease. In The Heart 2077-2125 (Eds Fuster V et al.) New York: McGraw-Hill Publishing Company , .
    • . . . Glycemia control lowers the risk of vascular diseases, by reducing the production of advanced glycosylation end-products,5 the accumulation of which is thought to promote atherosclerosis.6 The atherosclerosis-promoting effects of advanced glycosylation end-products are listed in Supplementary Box 1 online . . .
    • . . . Weight reduction and an exercise program should be instigated early, and the use of angiotensin-converting-enzyme inhibitors, statins and several oral hypoglycemic agents (such as thiazolidinediones and metformin) can be useful.6 Nevertheless, more than 25% of patients with diabetes have severe myocardial ischemia, myocardial infarction or both, without chest pain or chest discomfort.7 This finding raises an important question: should asymptomatic patients with type 2 diabetes be investigated for CAD and, if present, how should they be treated? . . .
  7. Cook SA et al. (2005) Therapy insight: heart disease and the insulin-resistant patient. Nat Clin Pract Cardiovasc Med 2: 252-259 , .
    • . . . Weight reduction and an exercise program should be instigated early, and the use of angiotensin-converting-enzyme inhibitors, statins and several oral hypoglycemic agents (such as thiazolidinediones and metformin) can be useful.6 Nevertheless, more than 25% of patients with diabetes have severe myocardial ischemia, myocardial infarction or both, without chest pain or chest discomfort.7 This finding raises an important question: should asymptomatic patients with type 2 diabetes be investigated for CAD and, if present, how should they be treated? . . .
  8. Nissen SE and Yock P (2001) Intravascular ultrasound: novel diagnostic insights and current clinical application. Circulation 103: 604-616 , .
    • . . . Modification of the coronary artery anatomy with remodeling of segmental CAD can result luminal stenosis remaining unseen on angio- graphy, even when intravascular ultrasound indicates a marked reduction in target coronary blood flow.8 Such patients might also have stress-test-induced myocardial ischemia, identifiable by myocardial perfusion imaging, or inducible echocardiographic wall-motion abnormalities . . .
  9. Wackers FJT et al. for the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Investigators (2004) Detection of silent myocardial ischemia in asymptomatic diabetic subjects. Diabetes Care 27: 1954-1961 , .
    • . . . In the prospective DIAD study,9 113 of the 522 patients with asymptomatic type 2 diabetes had silent ischemia . . .
Expand