The changing costs and benefits of screening for asymptomatic coronary heart disease in patients with diabetes

Martin Rutter, Martin K. Rutter, Richard W. Nesto

    Research output: Contribution to journalArticlepeer-review


    Aggressive medical therapy can be justified in most patients with diabetes, but there may be some higher-risk asymptomatic patients who could benefit from revascularization and/or medical therapy for myocardial ischemia. Silent myocardial ischemia (SMI) might be used to identify these high-risk individuals. In this Review we define SMI as objective evidence of ischemia from any noninvasive test occurring in an asymptomatic patient. We outline what is known about asymptomatic coronary heart disease (CHD) in diabetes and how this relates to SMI. We examine how SMI predicts angiographic CHD and CHD events, and we describe the changing role of CHD screening as reflected by various guidelines. We identify the recent research suggesting that there may be substantial numbers of high-risk asymptomatic patients who have diabetes with undiagnosed CHD and who could benefit from more-active intervention; however, with the recent advances in medical therapy, and the uncertain benefits of screening, current guidelines strongly discourage this practice, except in limited clinical situations, such as before major surgery. Carefully conducted clinical trails using state-of-the-art investigations and therapy in well-characterized patients with diabetes are urgently required to inform physicians on when and how to intervene. ©2007 Nature Publishing Group.
    Original languageEnglish
    Pages (from-to)26-35
    Number of pages9
    JournalNature Clinical Practice Endocrinology and Metabolism
    Issue number1
    Publication statusPublished - 25 Jan 2007


    • Coronary heart disease
    • Diabetes mellitus
    • Myocardial ischemia
    • Screening


    Dive into the research topics of 'The changing costs and benefits of screening for asymptomatic coronary heart disease in patients with diabetes'. Together they form a unique fingerprint.

    Cite this