Assessment of Cardiovascular Disease in Asymptomatic Adults with Type 2 Diabetes Mellitus
Assessment of Cardiovascular Disease in Asymptomatic Adults with Type 2 Diabetes Mellitus
July 2011
F.Sheikholeslami.MD
Assessment of CVD in Asymptomatic Adults with T2 DM
- The prevalence of DM 2.8% in 2000 and 4.4% in 2030.
- No of people with T2DM rise from 171 m in 2000 to 366 m in 2030, Iran 9% ? ~3M2010- 2030~ 8M
- CVD is responsible for 65% of deaths in T2DM patients,
- In 50% the initial presentation of CAD is a (MI) or SCD.
- After MI, the 30-day mortality rate in patients with T2DM is> 50%
- Shortening of life expectancy, 8 yrs for <65 and 4 yrs >65
Why we should screen
- DIAD study suggested that 20% asymptomatic patients with T2DM,aged 50−77 years had silent myocardial ischemia .
- In men 8% of silent cases are considered as high risk.
- 10 year mortality for known CAD in T2DM is 70%.
- Do blanket screening lead to better outcome?
High risk group of Asymptomatic Diabetic Patients which may benefit from further cardiac testing
- Abnormal resting ECG. e.g., abnormal Q wave.
- Evidence of peripheral or carotid occlusive arterial disease.
- Males>65 years√.
- Insulin Dependence.
- Longer duration of diabetes>10 years√.
- Poor glycemic control: HbA1c>7%.
- Family history of premature CAD√.
- Abnormality of autonomic markers. HRV ,Valsalva ,ED
- Abnormal test of atherosclerosis burden e.g. Coronary calcium index, carotid intima media thickness, ankles brachial index …...
- Preoperative investigation for major noncardiac surgery
- ADA guidelines recommend testing only for those individuals who have >2 risk factors (diabetic dyslipidemia, hypertension, active smoking, a family history of premature CAD, and albuminuria)
