Screening for silent coronary artery disease in diabetics- or not?

The association between diabetes mellitus and coronary artery disease (CAD) is wellknown. Being the leading cause of death in diabetics, CAD is a target for prevention, diagnosis and treatment. In that sense, silent CAD in diabetics has long been a matter of concern, leading both to continued attempts at its diagnosis as well as to the persisting challenge of defining if screening for CAD in the diabetic population is useful and/or warranted. The most frequent and stronger point in favor of screening rests on the assumption that early diagnosis of CAD may lead to early treatment and therefore improved outcomes. Nonetheless, screening for CAD in diabetics is a controversial issue, since studies have not yielded evidence supporting better outcomes in diabetics screened for CAD compared to nonscreened diabetics. For several reasons, current tests that detect inducible ischemia or assess atherosclerotic burden may not be able to identify those patients at increased risk. Therefore a cautious look should be taken (once more) at that question.