Screening for Silent Coronary Heart Disease in Type 2 Diabetes

Patients with type 2 diabetes suffer twice the cardiovascular mortality of patients without the disease (1,2). In 1998, the American Diabetes Association (ADA) published guidelines for early detection of coronary heart disease (CHD) in asymptomatic patients with diabetes, with a specific focus on patients with multiple cardiovascular risk factors (3). Patients that fulfill any criteria are to be further risk stratified with stress testing. The criteria include 1 ) typical or atypical cardiac symptoms; 2 ) resting electrocardiograph suggestive of ischemia or infarction; 3 ) peripheral or carotid occlusive disease; 4 ) sedentary lifestyle, aged ≥35 years, and plans to begin a vigorous exercise program; and 5 ) more than two of the following risk factors in addition to diabetes: total cholesterol ≥240 mg/dl, LDL cholesterol ≥160 m/dl, or HDL cholesterol 140/90 mmHg; smoking; family history of premature coronary artery disease; or micro-/macroalbuminuria. However, there are limited data available evaluating the performance of these guidelines in a clinical setting. We determined the proportion of patients in our clinic with type 2 diabetes that satisfied the ADA screening criteria and prevalence of CHD in these patients using stress testing and cardiac catheterization. In 1999, records of patients ( n = 2,226) in the Joslin Center at the University of Maryland Medical Center …