Should adults with type 2 diabetes be screened for atherosclerotic cardiovascular disease?

Abstract

Diabetes mellitus is associated with greater risks for cardiovascular diseases (CVD). Multiple noninvasive screening tools for CVD including cardiac CT, carotid intima-media thickness test, myocardial perfusion imaging have been examined in those with diabetes, but the prognostic value of these tests vary and issues remain regarding their cost-benefit ratios, potential harms of radiation, and how they fit into screening algorithms for CVD. We discuss in this report the needs and criteria for screening tests and summarize the evidence from observational studies and clinical trials. We also explore whether there should be more sensitive screening modalities to better detect both short and long-term cardiovascular risk among asymptomatic patients with diabetes.

Cardiovascular risk assessment and screening in diabetes

“…Using the Atherosclerosis Risk in Communities Study, a larger US cohort, Nambi et al [43] showed that 23% of patients were reclassified on adding CIMT to traditional risk factors, with a net improvement index of 9.9%. Meta-analysis and pooled cohort studies showed that the addition of common CIMT to traditional risk models was associated with only a modest improvement and may not be clinically useful [44]. CIMT is therefore not recommended in the current AHA/ACC risk assessment guidelines.…”

Detection and quantification of coronary calcium from dual energy chest x‐rays: Phantom feasibility study

“…(Defined ASCVD events do not include peripheral artery disease, heart failure, revascularization, and other atherosclerosis‐related, life‐altering events.) Calcium score can play a particular role for high risk groups having diabetes, rheumatoid arthritis, HIV, etc . Despite great enthusiasm among many physicians for CT coronary calcium score, there is little support for population screening due to its costs (both patient charges and radiation).…”

“…Calcium score can play a particular role for high risk groups having diabetes, rheumatoid arthritis, HIV, etc. 10,[14][15][16][17][18][19][20][21][22] Despite great enthusiasm among many physicians for CT coronary calcium score, there is little support for population screening due to its costs (both patient charges and radiation).…”