Noninvasive screening for coronary atherosclerosis and silent ischemia in asymptomatic type 2 diabetic patients: is it appropriate and cost-effective?

J Am Coll Cardiol. 2007 May 15;49(19):1918-23. doi: 10.1016/j.jacc.2007.01.079. Epub 2007 Apr 30.


Coronary artery disease (CAD) accounts for 65% to 80% of deaths in diabetic patients. The merits of screening asymptomatic type 2 diabetic patients for either (A) the presence of coronary atherosclerosis by imaging of coronary calcification using cardiac computed tomography or (B) silent ischemia by stress myocardial perfusion imaging (MPI) remain controversial. Some observers have advocated for such noninvasive screening in at least the subset of the diabetic population who have significant clinical CAD risk factors, so that the highest risk patients for future cardiac events can be identified and offered more aggressive intensive medical therapy or coronary revascularization and optimum medical therapy. Computed tomography coronary calcium scanning could be the first noninvasive screening test in these clinically high-risk diabetic patients, followed by stress MPI to detect silent ischemia in those who exhibit high coronary calcium scores.

MeSH terms

  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / etiology
  • Coronary Artery Disease / prevention & control
  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 2 / complications*
  • Diagnostic Imaging / economics
  • Humans
  • Mass Screening / economics*
  • Myocardial Ischemia / diagnosis*
  • Myocardial Ischemia / etiology
  • Myocardial Ischemia / prevention & control
  • Patient Selection