Screening subclinical coronary artery disease with noninvasive modalities in patients with diabetes

Diabetes mellitus is a global epidemic crisis as well as a major risk factor for coronary artery disease. Although several well-known noninvasive screening modalities including cardiac computed tomography, echocardiography, and myocardial perfusion imaging have been examined, controversies exist on the prognostic efficacy of these tests. Little is known with regard to the cost–benefit ratios and potential harms of radiation, and no standard screening algorithms have been established. In this review, we discuss the need and criteria for good testing methods and then summarize some of the latest evidence from either randomized or nonrandomized studies to see whether they may possibly strengthen current recommendations and extend the application of these screening methods in related guidelines. We propose, in the future, the development of newer, more sensitive screening modalities to better detect both short-term and long-term cardiovascular risk among asymptomatic patients with diabetes.