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Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient: The Imaging Council of the American
Matthew J Budoff1, Paolo Raggi2, George A Beller3
1Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California.
Insights
Type 2 diabetes significantly increases cardiovascular disease risk. New guidelines suggest risk stratification using noninvasive testing for asymptomatic patients with diabetes before universal treatment.
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Type 2 diabetes (T2D) is linked to a twofold increased risk of coronary heart disease (CHD).
- Cardiovascular disease accounts for two-thirds of deaths in diabetic patients.
- The concept of 'coronary risk equivalent' for diabetes is debated due to risk heterogeneity.
Purpose of the Study:
- To review noninvasive testing modalities for CHD risk stratification in asymptomatic T2D patients.
- To develop an evidence-based algorithm for screening T2D patients.
- To address evolving guidelines on risk assessment in diabetes.
Main Methods:
- Systematic review of noninvasive imaging modalities for CHD risk stratification.
- Analysis of data and recommendations from the American College of Cardiology Imaging Council.
- Evaluation of evidence for risk stratification in asymptomatic T2D individuals.
Main Results:
- Evidence supports risk stratification over universal treatment for T2D patients.
- Noninvasive testing can identify varying CHD risk levels in asymptomatic T2D individuals.
- Guidelines increasingly acknowledge the need for personalized risk assessment.
Conclusions:
- Risk stratification is crucial for managing cardiovascular risk in T2D.
- Noninvasive testing plays a key role in identifying high-risk T2D patients.
- An algorithm for screening can guide clinical decision-making for T2D patients.
Abstract:
Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a "coronary risk equivalent," implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies from different cohorts provided varying conclusions on the validity of the concept of coronary risk equivalency in patients with diabetes. New guidelines have started to acknowledge the heterogeneity in risk and include different treatment recommendations for diabetic patients without other risk factors who are considered to be at lower risk. Furthermore, guidelines have suggested that further risk stratification in patients with diabetes is warranted before universal treatment. The Imaging Council of the American College of Cardiology systematically reviewed all modalities commonly used for risk stratification in persons with diabetes mellitus and summarized the data and recommendations. This document reviews the evidence regarding the use of noninvasive testing to stratify asymptomatic patients with diabetes with regard to coronary heart disease risk and develops an algorithm for screening based on available data.
