Detection of Occult Coronary Artery Disease in Asymptomatic Individuals With Diabetes Mellitus Using Non-Invasive Cardiac Angiography

Atherosclerosis. 2009 Apr;203(2):442-8. doi: 10.1016/j.atherosclerosis.2008.07.030. Epub 2008 Aug 5.


Introduction/objectives: Cardiovascular disease is the leading cause of death for individuals with diabetes mellitus. Controversy exists regarding the screening of asymptomatic diabetics for occult coronary artery disease (CAD). The purpose of this study is to describe the prevalence of occult CAD in a group of asymptomatic subjects with diabetes using non-invasive coronary angiography, as well as to investigate the predictive accuracy of current guidelines with regards to their recommended criteria for further cardiac diagnostic testing in this patient population.

Methods: We prospectively enrolled 217 asymptomatic Korean outpatients with type 2 diabetes who had no prior history of CAD. All underwent non-invasive coronary angiography using a 64-slice multi-detector computed tomography scanner.

Results: The mean age of the study participants was 59+/-8 years; 66% were men. Diabetes duration was 7+/-7 years, mean Framingham risk score was 13%, and mean hemoglobin A1C level was 7%. Of the 217 outpatients, 138 (64%) had occult CAD based on cardiac computed tomography angiography (CCTA) findings. Thirty-six (36/138; 26%) had a significant stenosis on CCTA. Nearly half of the individuals (62/138; 45%) had a combination of non-calcified and calcified plaques. Only 5 out of 217 (2%) individuals with significant stenosis would have been missed using the American Diabetes Association (ADA) criteria for further cardiac testing.

Conclusion: Almost two thirds of asymptomatic diabetics have occult CAD, including obstructive disease. Based on CCTA findings, the ADA criteria for further cardiac diagnostic testing would identify most individuals who have a significant coronary stenosis.

MeSH terms

  • Aged
  • Coronary Angiography / methods*
  • Coronary Artery Disease / diagnosis*
  • Diabetes Complications / diagnosis
  • Diabetes Mellitus / diagnosis*
  • Diabetes Mellitus / pathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Reproducibility of Results
  • Risk
  • Risk Factors
  • Tomography, X-Ray Computed / methods