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

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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.

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Authors and Affiliations

  1. Internal Medicine, Vascular and Endocrine-Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute “Beato Matteo” ICBM, Hospital Group San Donato, Via Aselli, 5, 27100, Vigevano, Pavia, Italy

    Carmine Gazzaruso, Adriana Coppola & Pietro Gallotti

  2. Department of Internal Medicine, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy

    Carmine Gazzaruso & Gabriele Pelissero

  3. Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy

    Tiziana Montalcini & Arturo Pujia

  4. Cardiology Unit, A.O. Province of Pavia, Voghera, Italy

    Cinzia Valenti

  5. Department of Internal Medicine, University of Pavia, Pavia, Italy

    Sebastiano Bruno Solerte

  6. Cardiology Unit, Santa Rita Institute, Vercelli, Italy

    Fabrizio Salvucci

  7. Diabetes Centre, A.O. Province of Pavia, Pavia, Italy

    Adriana Garzaniti

  8. Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy

    Andrea Giustina

Authors
  1. Carmine Gazzaruso
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  2. Adriana Coppola
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  4. Cinzia Valenti
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  6. Sebastiano Bruno Solerte
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  7. Fabrizio Salvucci
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  9. Arturo Pujia
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  10. Adriana Garzaniti
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  11. Andrea Giustina
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Correspondence to Carmine Gazzaruso.

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Gazzaruso, C., Coppola, A., Montalcini, T. et al. Screening for asymptomatic coronary artery disease can reduce cardiovascular mortality and morbidity in type 2 diabetic patients. Intern Emerg Med 7, 257–266 (2012). https://doi.org/10.1007/s11739-011-0527-5

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