Patients with diabetes are known to be at increased risk for coronary artery disease as well as silent ischemia.  The Detection of Ischemia in Asymptomatic Diabetics (DIAD) trial evaluated using adenosine-stress radionuclide myocardial perfusion imaging to screen 1,123 patients with diabetes who had no cardiovascular symptoms.  No significant differences were found between screening and no-screening groups for cardiac mortality (1.4% vs. 1.2%), all-cause mortality (3.2% vs. 2.7%) or rate of myocardial infarction (1.3% vs. 1.7%) (level 2 [mid-level] evidence).  Use of medications for primary prevention (aspirin, ACE inhibitors and statins) and glycemic control increased significantly in both groups over the course of the study.  The cumulative cardiac event rate of 2.9% over mean 4.8 years follow-up was significantly lower than anticipated in the trial design, which may have caused the study to be underpowered (JAMA 2009 Apr 15;301(15):1547). 

For more information, see the Screening information in the Coronary artery disease (CAD) topic in DynaMed.

In a 1998 Finnish cohort study, the 7-year risk of myocardial infarction from diabetes was found to be the same as that of having a history of previous myocardial infarction (N Engl J Med 1998 Jul 23;339(4):229). These findings were not confirmed in a 2002 Scottish study (BMJ 2002 Apr 20;324(7343):939).  A recent systematic review and meta-analysis of 13 studies with 45,108 patients followed for a mean of 13.4 years found that diabetes alone is a significantly weaker predictor of cardiovascular outcomes (Diabet Med 2009 Feb;26(2):142).  Patients with diabetes but no prior myocardial infarction had a 43% lower risk of developing total coronary heart disease events compared with patients with previous myocardial infarction but no history of  diabetes (summary odds ratio 0.56, 95% confidence interval 0.53-0.6).

For more information, see the Coronary artery disease major risk factors topic in DynaMed.

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