Screening for asymptomatic coronary artery disease can reduce cardiovascular mortality and morbidity in type 2 diabetic patients

Abstract

The impact of the screening for asymptomatic coronary artery disease (CAD) on the cardiovascular prognosis in diabetes is controversial. The aim of the study was to investigate whether screening for asymptomatic CAD can have an impact on cardiovascular morbidity and mortality in diabetes. In this nonrandomized longitudinal study, 1,189 consecutive type 2 diabetic patients without a history of CAD were evaluated. They were subdivided into two groups according to whether they were screened (screening group, n = 921) or not (no-screening group, n = 268) for asymptomatic CAD. Among the screened patients, 386 had angiographically proven CAD (CAD group) and 535 did not have silent CAD (no-CAD group). During a mean follow-up period of 4.3 ± 1.9 years, 130 patients experienced major adverse cardiac events (MACE). The incidence of MACE was significantly greater in the no-screening than in the screening group (22.0 vs. 7.7%; p = 0.001). The Kaplan-Meier method showed that: (1) the screening was associated with a lower rate of MACE (log-rank test, 3-95; p = 0.047); (2) the no-screening group had a risk profile similar to that of CAD group (log-rank test, 2.02; p = 0.154); and (3) cardiovascular prognosis was significantly better in no-CAD than in no-screening group (log-rank test, 4.27; p = 0.039). Multivariate Cox regression analysis showed that screening for CAD (HR 0.2; 95% CI 0.2-0.3; p = 0.000) was significantly protective against the occurrence of MACE. Our data suggest that screening for asymptomatic CAD can significantly reduce cardiovascular morbidity and mortality in type 2 diabetic patients. This may be due to specific diagnostic and therapeutic interventions in diabetic patients with proven CAD at screening.