Asymptomatic subjects with diabetes have a comparable risk of coronary artery disease to Non-diabetic subjects presenting chest pain: a 4-year community-based prospective study

BMC Cardiovascular Disorders

Min Kyong Moon¹  Kyong Soo Park²  Yun Gi Kim²  Bo Kyung Koo¹ 

[1] Department of Internal Medicine, Boramae Medical Center, Seoul, South Korea;Department of Internal Medicine, Seoul National University College of Medicine, 39 Boramae Road, Seoul, Dongjak-Gu 156-707, South Korea

关键词: Chest pain;    Coronary artery disease;    Diabetes;   

Others  :  856785
DOI  :  10.1186/1471-2261-13-87

 received in 2013-01-23, accepted in 2013-10-15,  发布年份 2013

【 摘 要 】

Background

Although diabetes mellitus is an important risk factor of coronary artery disease (CAD), routine screening for CAD is not recommended for asymptomatic diabetic patients. We assessed the impact of chest pain on CAD risk according to the presence or absence of diabetes mellitus.

Methods

We investigated the future CAD event rate in subjects with and without chest pain according to the presence or absence of diabetes in a prospective large-scale community-based study in Korea.

Results

Among 8,574 subjects (4,032 men and 4,542 women) without a history of CAD, 0.8% and 2.2% of non-diabetic and diabetic subjects, respectively, reported newly developed CAD events during 4 years of follow-up. Although the presence of chest pain at baseline was also significantly associated with an increased risk of CAD of more than 2-fold in both non-diabetic and diabetic subjects (P < 0.01), the risk of future CVD event in asymptomatic diabetic patients was not significantly different from that in non-diabetic subjects with chest pain (hazard ratio, 0.907; 95% confidence interval, 0.412 – 1.998).

Conclusions

The CAD event rate of asymptomatic subjects with diabetes was comparable to that of non-diabetic subjects reporting chest pain. Considering the high risk of CAD in asymptomatic diabetic patients, more clinical trials aimed at formulating strategies to screen asymptomatic diabetic subjects should be carried out.

【 授权许可】

   
2013 Koo et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M: Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998, 339:229-234.
• [2]Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ, Taillefer R, Wittlin SD, Heller GV, Filipchuk N, et al.: Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care 2004, 27:1954-1961.
• [3]Scognamiglio R, Negut C, Ramondo A, Tiengo A, Avogaro A: Detection of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus. J Am Coll Cardiol 2006, 47:65-71.
• [4]Young LH, Wackers FJ, Chyun DA, Davey JA, Barrett EJ, Taillefer R, Heller GV, Iskandrian AE, Wittlin SD, Filipchuk N, et al.: Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. Jama 2009, 301:1547-1555.
• [5]Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF, MacGregor JM, Orchard TJ, Chaitman BR, Genuth SM, Goldberg SH, et al.: A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med 2009, 360:2503-2515.
• [6]Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, et al.: Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007, 356:1503-1516.
• [7]American Diabetes Association: Standards of medical care in diabetes-2012. Diabetes Care 2012, 35(Suppl 1):S11-S63.
• [8]Valensi P, Paries J, Brulport-Cerisier V, Torremocha F, Sachs RN, Vanzetto G, Cosson E, Lormeau B, Attali JR, Marechaud R, et al.: Predictive value of silent myocardial ischemia for cardiac events in diabetic patients: influence of age in a French multicenter study. Diabetes Care 2005, 28:2722-2727.
• [9]Choi EK, Koo BK, Kim HS, Cho YM, Kang HJ, Cho YS, Chung WY, Chae IH, Choi DJ, Oh BH, et al.: Prognostic significance of asymptomatic coronary artery disease in patients with diabetes and need for early revascularization therapy. Diabet Med 2007, 24:1003-1011.
• [10]Cho NH, Jang HC, Choi SH, Kim HR, Lee HK, Chan JC, Lim S: Abnormal liver function test predicts type 2 diabetes: a community-based prospective study. Diabetes Care 2007, 30:2566-2568.
• [11]Choi SH, Kim TH, Lim S, Park KS, Jang HC, Cho NH: Hemoglobin A1c as a diagnostic tool for diabetes screening and new-onset diabetes prediction: a 6-year community-based prospective study. Diabetes Care 2011, 34:944-949.
• [12]Statistics Korea: Population census. In Book Population Census. City: Daejeon; 2000.
• [13]Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, et al.: Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005, 112:2735-2752.
• [14]Stamler J, Vaccaro O, Neaton JD, Wentworth D: Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993, 16:434-444.
• [15]Pfisterer M: Long-term outcome in elderly patients with chronic angina managed invasively versus by optimized medical therapy: four-year follow-up of the randomized Trial of Invasive versus Medical therapy in Elderly patients (TIME). Circulation 2004, 110:1213-1218.
• [16]Weiner DA, Ryan TJ, Parsons L, Fisher LD, Chaitman BR, Sheffield LT, Tristani FE: Significance of silent myocardial ischemia during exercise testing in patients with diabetes mellitus: a report from the Coronary Artery Surgery Study (CASS) Registry. Am J Cardiol 1991, 68:729-734.
• [17]Vinik AI, Maser RE, Mitchell BD, Freeman R: Diabetic autonomic neuropathy. Diabetes Care 2003, 26:1553-1579.
• [18]Klein BE, Klein R, McBride PE, Cruickshanks KJ, Palta M, Knudtson MD, Moss SE, Reinke JO: Cardiovascular disease, mortality, and retinal microvascular characteristics in type 1 diabetes: Wisconsin epidemiologic study of diabetic retinopathy. Arch Intern Med 2004, 164:1917-1924.
• [19]Hiller R, Sperduto RD, Podgor MJ, Ferris FL 3rd, Wilson PW: Diabetic retinopathy and cardiovascular disease in type II diabetics. The Framingham Heart Study and the Framingham Eye Study. Am J Epidemiol 1988, 128:402-409.
• [20]Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S: Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 2001, 134:629-636.
• [21]Doobay AV, Anand SS: Sensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: a systematic review. Arterioscler Thromb Vasc Biol 2005, 25:1463-1469.
• [22]The Korean Ministry of Health and Welfare: Report of The Korean National Health and Nutrition Examination Survey 2001. In Book Report of The Korean National Health and Nutrition Examination Survey 2001. City: Seoul; 2003.
• [23]Gaede P, Lund-Andersen H, Parving HH, Pedersen O: Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008, 358:580-591.
• [24]Gregg EW, Cheng YJ, Saydah S, Cowie C, Garfield S, Geiss L, Barker L: Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006: findings from the National Health Interview Survey. Diabetes Care 2012, 35:1252-1257.
• [25]Choi EK, Chun EJ, Choi SI, Chang SA, Choi SH, Lim S, Rivera JJ, Nasir K, Blumenthal RS, Jang HC, Chang HJ: Assessment of subclinical coronary atherosclerosis in asymptomatic patients with type 2 diabetes mellitus with single photon emission computed tomography and coronary computed tomography angiography. Am J Cardiol 2009, 104:890-896.
• [26]Hadamitzky M, Hein F, Meyer T, Bischoff B, Martinoff S, Schomig A, Hausleiter J: Prognostic value of coronary computed tomographic angiography in diabetic patients without known coronary artery disease. Diabetes Care 2010, 33:1358-1363.
• [27]Elkeles RS, Godsland IF, Feher MD, Rubens MB, Roughton M, Nugara F, Humphries SE, Richmond W, Flather MD: Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study. Eur Heart J 2008, 29:2244-2251.