Routine screening for coronary artery disease is of no value for adults with diabetes who have no symptoms of heart problems, says a report in the Journal of the American Medical Association.
Screening is expensive, at $1,000 per test. But the study of 1,123 people with type 2 diabetes who had no symptoms of heart disease did not identify those at high risk of developing cardiac problems.
"It was a surprise," says Dr. Lawrence H. Young, professor of medicine at Yale University and a leader of the study. "There is no question that coronary artery disease is still a major concern in patients with type 2 diabetes."
While the study did identify a small group of people at increased risk of coronary artery disease, "in the overall population, patients who were screened did not have a better outcome specifically in terms of heart attacks and cardiac death," says Dr. Young.
For physicians managing people with type 2 diabetes, Dr. Young says, "The implication is that a routine patient who is doing well, on state-of-the-art medication such as cholesterol-lowering drugs, aspirin, and diabetes therapy, need not be subjected to specialized stress testing."
"But patients who have any symptoms of heart disease need to be screened," he adds.
Study participants were randomly assigned to have either a sophisticated screening test - adenosine-stress radionuclide myocardial perfusion imaging - or no test.
In a follow-up period averaging 4.8 years, 2.7 percent of the people in the screened group had heart attacks or died of cardiac disease, compared to 3.0 percent of those who were not screened.
Many of the people in the study had well-known risk factors for heart disease, explains Dr. Young.
"In our study, most patients were overweight, and many had other risk factors such as hypertension [high blood pressure] and high cholesterol," he says. "But those were treated well by the primary-care physicians."
Diabetics who should be screened are those with a family history of heart disease or have symptoms of cardiac problems, such as the chest pain called angina, feeling of tightness and heaviness in the chest, and unexplained shortness of breath on exertion, Dr. Young explains.
One possible reason for the negative finding in the study is that plans for the trial were made eight or nine years ago, and preventive measures have improved since then, notes Dr. Steven D. Wittlin, professor of medicine at the University of Rochester in New York, and a member of the research team.
The incidence of heart problems found in the study was lower than had been expected, he says.
"During that time, a lot more people have gone on aspirin and ACE inhibitors and other drugs, and that may account for the low rate," says Dr. Wittlin.
There are two major findings in the study, he says.
"On the one hand, it verifies that people with type 2 diabetes who are middle-aged and have a positive stress test have an increased risk of a cardiac event," he says. "But the event rate was low enough so that it does not appear to be cost-effective to routinely screen patients with a nuclear stress test."
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Heart and vascular disease often go hand-in-hand with diabetes. Persons with diabetes are at a much greater risk for heart attacks, strokes, and high blood pressure.
Other vascular problems from diabetes include poor circulation to the legs and feet. Unfortunately, many of the cardiovascular problems can go undetected and can start early in life.
Serious cardiovascular disease can begin before the age of 30 in persons with diabetes. The two most common types of diabetes are type 1 and type 2.
Type 1 diabetes (also called insulin-dependent diabetes mellitus) is an autoimmune disease in which the body's immune system attacks the cells in the pancreas that produce insulin, resulting in no insulin or a low amount of insulin.
Type 2 diabetes (also called non-insulin dependent diabetes mellitus) is the result of the body's inability to make enough insulin, or to properly use it.
According to the American Diabetes Association, damage to the coronary arteries is two to four times more likely in asymptomatic persons with type 1 diabetes than in the general population.
Because symptoms may be absent at first, the American Diabetes Association recommends early diagnosis and treatment, and management of risk factors.
Many studies demonstrate that persons with type 2 diabetes are at increased risk for heart disease. In fact, one study found that persons with type 2 diabetes without apparent heart problems ran the same risk for heart disease as persons without diabetes who had already suffered one heart attack.
Persons with diabetes often experience changes in the blood vessels that can lead to cardiovascular disease. In persons with diabetes, the linings of the blood vessels may become thicker, making it more difficult for blood to flow through the vessels.
When blood flow is impaired, heart problems or stroke can occur. Blood vessels can also suffer damage elsewhere in the body due to diabetes, leading to eye problems, kidney problems, and poor circulation to the legs and feet.
Metabolic syndrome is characterized by a group of metabolic risk factors in one person. People with metabolic syndrome are at increased risk of coronary heart disease, other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease), and type 2 diabetes, according to the American Heart Association. Risk factors for metabolic syndrome include.
Always consult your physician for more information.