Diabetes: how to predict silent coronary artery disease

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Takeaway

  • Several factors such as male sex and disease duration are associated with abnormal myocardial perfusion scintigraphy (MPS) in patients with asymptomatic diabetes but at high risk for coronary artery disease (CAD).

Why this matters

  • Silent CAD may affect as many as one-quarter of patients with diabetes, making its detection critical.

Study design 

  • Prospective multicenter trial.
  • Researchers performed MPS on 400 high-CAD-risk patients with diabetes with or without prior CAD.
  • Funding: Swiss National Foundation for Research; Swiss Heart Foundation; Basel Foundation for Cardiovascular Research; Diabetes Association, Basel; Roche; Pfizer; Takeda; Heider & Co; Switzerland. 

Key results 

  • 50% of patients receiving insulin, 80% oral glucose lowering drugs.
  • 22% of patients had abnormal baseline MPS.
  • In multivariate models, male sex (OR, 2.223; P=.017), diabetes duration (OR, 1.049; P=.005), peripheral arterial disease (OR, 2.134; P=.016), smoking (OR, 2.064; P=.022), systolic BP (OR, 1.014; P=.056), and brain natriuretic peptide (OR, 1.002; P=.005) were independent predictors of abnormal MPS at baseline.
  • Patients with ≥10% abnormal myocardium had 6.8-fold higher risk for cardiac death (P=.045), 6.8-fold higher cardiac or myocardial infarction rate (P=.007), and 5-fold higher major adverse cardiac events rate (P<.001) compared with patients of <10%.

Limitations

  • Study cannot comment on management of these patients.