Screening and Risk Assessment of Coronary Artery Disease in Patients With Type 2 Diabetes: An Updated Review

Patsouras, Alexandros; Farmaki, Paraskevi; Garmpi, Anna; Damaskos, Christos; Garmpis, Nikolaos; Mantas, Dimitrios; Diamantis, Evangelos

doi:10.21873/invivo.11572

Cited by 30 publications

(24 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, regular screening for cardiac ischemia is highly recommended, regardless of the presence or absence of angina. Screening may be performed as it is for CAD in diabetic patients, using either a physical or pharmacological stress test (preferably with imaging, such as echo-stress, or with myocardial scintigraphy), computed tomography calcium score, or other methods (according to the availability of the tests in a given center), as well as balancing diagnostic utility, and cost and risk for the patient (33)(34)(35)(36).…”

Section: Discussionmentioning

confidence: 99%

Cardiologic Long-Term Follow-Up of Patients Treated With Chest Radiotherapy: When and How?

Lestuzzi

Mascarin

Coassin

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Introduction: Radiotherapy may cause valvular (VHD), pericardial, coronary artery disease (CAD), left ventricular dysfunction (LVD), arrhythmias. The risk of radiation induced heart disease (RIHD) increases over time. The current guidelines suggest a screening for RIHD every 5 years in the long-term survivors who had been treated by chest RT.Methods: We reviewed the clinical and instrumental data of 106 patients diagnosed with RIHD. In one group (Group A: 69 patients) RIHD was diagnosed in an asymptomatic phase through a screening with ECG, echocardiogram and stress test. A second group (37 patients) was seen when RIHD was symptomatic. We compared the characteristics of the two groups at the time of RT, of RIHD detection and at last follow-up.Results: Overall, 64 patients (60%) had CAD (associated to other RIHD in 18); 39 (36.7%) had LVD (isolated in 20); 24 (22.6%) had VHD (isolated in 10 cases). The interval between the last negative test and the diagnosis of moderate or severe RIHD was <5 years in 26 patients, and <4 years in 18. In group A, 63% of the patients with CAD had silent ischemia. The two groups did not differ with regard to type of tumor, cardiovascular risk factors, use of anthracycline-based chemotherapy, age at RT treatment, radiation dose and interval between RT and toxicity detection. The mean time from RT and RIHD was 16 years in group A and 15 in group B. Interventional therapy at RIHD diagnosis was more frequent in group B (54 vs. 30%, p < 0.05). At last follow-up, 27 patients had died (12 of cancer, 9 of cardiac causes, 6 of other causes); mean ejection fraction was 60% in group A and 50% in group B (p < 0.01). Patients with ejection fraction ≤ 50% were 14.5% in group A and 40% in group B (p < 0.01).Conclusions: Clinically relevant RIHD become evident at a mean interval of 16 years after RT. The most frequent clinical manifestations are CAD and LVD. RIHD diagnosis in asymptomatic patients may preserve their cardiac function with timely interventions. We suggest -after 10 years from radiotherapy- a screening every 2–3 years.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiologic Long-Term Follow-Up of Patients Treated With Chest Radiotherapy: When and How?

Lestuzzi

Mascarin

Coassin

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…PCI is more challenging to operate when ischemia occurs in patients with a long-term history of DM, especially those without well-controlled blood sugar (23)(24)(25). The diffused coronary lesions lead to ventricular remodeling and refractory HF (26,27). These patients are also at risk of suffering from malignant arrhythmia, renal dysfunction, and even SCD (28,29).…”

Section: Discussionmentioning

confidence: 99%

Serum level of fibroblast growth factor 21 predicts long-term prognosis in patients with both diabetes mellitus and coronary artery calcification

Guo¹,

Huang²,

Dai³

et al. 2020

Ann Palliat Med

View full text Add to dashboard Cite

show abstract

“…However, no single biomarker has been found to be completely reliable. Hence, using multiple biomarkers is the way forward in reaching a timely diagnosis of CAD[ 49 , 50 ].…”

Section: Dm and Cadmentioning

confidence: 99%

“…Small dense LDL particles are more atherogenic due to their specific characteristics, which include lower binding affinity to LDL receptors, higher penetration into the subendothelial layer, longer half-life, and lower resistance to oxidative stress[ 49 ]. Glycated apolipoprotein B can be used as a surrogate marker of subclinical atherosclerosis[ 51 ].…”

Section: Dm and Cadmentioning

confidence: 99%

Diabetic heart disease: A clinical update

Rajbhandari¹,

Fernandez²,

Agarwal³

et al. 2021

WJD

View full text Add to dashboard Cite

Diabetes mellitus (DM) significantly increases the risk of heart disease, and DM-related healthcare expenditure is predominantly for the management of cardiovascular complications. Diabetic heart disease is a conglomeration of coronary artery disease (CAD), cardiac autonomic neuropathy (CAN), and diabetic cardiomyopathy (DCM). The Framingham study clearly showed a 2 to 4-fold excess risk of CAD in patients with DM. Pathogenic mechanisms, clinical presentation, and management options for DM-associated CAD are somewhat different from CAD among nondiabetics. Higher prevalence at a lower age and more aggressive disease in DM-associated CAD make diabetic individuals more vulnerable to premature death. Although common among diabetic individuals, CAN and DCM are often under-recognised and undiagnosed cardiac complications. Structural and functional alterations in the myocardial innervation related to uncontrolled diabetes result in damage to cardiac autonomic nerves, causing CAN. Similarly, damage to the cardiomyocytes from complex pathophysiological processes of uncontrolled DM results in DCM, a form of cardiomyopathy diagnosed in the absence of other causes for structural heart disease. Though optimal management of DM from early stages of the disease can reduce the risk of diabetic heart disease, it is often impractical in the real world due to many reasons. Therefore, it is imperative for every clinician involved in diabetes care to have a good understanding of the pathophysiology, clinical picture, diagnostic methods, and management of diabetes-related cardiac illness, to reduce morbidity and mortality among patients. This clinical review is to empower the global scientific fraternity with up-to-date knowledge on diabetic heart disease.

show abstract

Screening and Risk Assessment of Coronary Artery Disease in Patients With Type 2 Diabetes: An Updated Review

Cited by 30 publications

References 47 publications

Cardiologic Long-Term Follow-Up of Patients Treated With Chest Radiotherapy: When and How?

Cardiologic Long-Term Follow-Up of Patients Treated With Chest Radiotherapy: When and How?

Serum level of fibroblast growth factor 21 predicts long-term prognosis in patients with both diabetes mellitus and coronary artery calcification

Diabetic heart disease: A clinical update

Contact Info

Product

Resources

About