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Coronary Computed Tomography Angiography for Screening in Patients with Diabetes: Can Enhanced Detection of Subclinical Coronary Atherosclerosis Improve Outcome?

Current Atherosclerosis Reports volume 18, Article number: 64 (2016) Cite this article

Abstract

Purpose of Review

It is well known that there is a very high risk of cardiovascular complications among diabetic patients. In spite of all efforts at aggressive control of diabetes and its complications, the incidence of cardiovascular morbidity and mortality remains high, including in patients with no prior symptoms, underscoring a possible advantage for appropriate screening of asymptomatic patients for the presence of obstructive coronary artery disease (CAD). In this article, we sought primarily to review the results of studies designed to evaluate a possible role of coronary computed tomography angiography (CCTA) in the screening of asymptomatic diabetic patients for possible obstructive CAD.

Recent Findings

Our review of current literature indicates that there is still no method of CAD screening identified that has been shown to reduce the cardiovascular risk of asymptomatic diabetic patients. Therefore, the utility and value of screening for CAD in asymptomatic diabetic patients remains controversial. CCTA screening has shown promise and has been demonstrated to predict future risk, but as yet has not demonstrated improvement in the outcomes of these high-risk patients.

Summary

At our present state of knowledge, aggressive risk factor reduction appears to be the most important primary prevention strategy for all asymptomatic high-risk diabetic patients. However, there remains a great need for better and more sensitive and specific screening methods, as well as more effective treatments that may allow us to more accurately target diabetic patients who really are at high risk. Further large randomized and well-controlled clinical trials may be necessary to determine whether screening for CAD can reduce cardiovascular event rates in patients with diabetes.

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Authors and Affiliations

  1. Intermountain Heart Institute, Intermountain Healthcare, 5121 S. Cottonwood Street, Salt Lake City, UT, USA

    Joseph Brent Muhlestein & Fidela Ll Moreno

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  1. Joseph Brent Muhlestein
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  2. Fidela Ll Moreno
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Correspondence to Joseph Brent Muhlestein.

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Joseph Brent Muhlestein and Fidela Ll. Moreno declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Clinical Trials and Their Interpretations

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Muhlestein, J.B., Moreno, F.L. Coronary Computed Tomography Angiography for Screening in Patients with Diabetes: Can Enhanced Detection of Subclinical Coronary Atherosclerosis Improve Outcome?. Curr Atheroscler Rep 18, 64 (2016). https://doi.org/10.1007/s11883-016-0620-3

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  • DOI: https://doi.org/10.1007/s11883-016-0620-3

Keywords

  • Coronary artery disease
  • CAD
  • Diabetes
  • CAD screening
  • Coronary computed tomography angiography
  • CCTA