Prognostic significance of silent coronary artery disease in type 2 diabetes.

The prevalence of obesity and diabetes is increasing rapidly. Coronary artery disease (CAD) represents the leading cause of death in diabetic patients. Diabetic patients are at a two- to fourfold risk of cardiovascular mortality compared with their nondiabetic counterparts. Silent myocardial ischemia more often occurs in diabetics than in nondiabetics. In general, the prevalence of silent CAD varies depending on the test used for patient screening and on the patient population screened. The prevalence of silent CAD is 6-23% in low-risk diabetic patients. In high-risk diabetic patients the prevalence may be as high as 60%. Over the last years it has been well recognized that silent CAD is not different from symptomatic CAD with respect to prognosis and adverse events. Particular diabetic patients therefore might benefit from routine CAD screening. CAD could be diagnosed at an earlier stage of disease and be treated accordingly. Myocardial perfusion SPECT, stress echocardiography and possibly computed tomography are emerging as effective screening tools beyond risk stratification by risk factor scoring systems alone. There are few studies suggesting that early intervention by medical or also revascularization strategies could lead to a better outcome in diabetic patients with evidence of silent CAD.