Authors' reply.

Sir,

This is in response to the queries raised about the review, ‘The screening of Coronary Artery Disease in patients with type 2 diabetes mellitus — An evidence based review.’ We appreciate the comments expressed by the author, however, we would like to point out the following observations.

It is an undisputed fact that diabetes mellitus (DM) predisposes to cardiovascular diseases (CVDs). Diabetic patients have been reported to have a two to four-fold increased risk of both developing and dying of coronary heart disease (CHD) in comparison to non- diabetics.[1]

The author of the letter has pointed out that type 2 diabetes is no longer considered as a CHD risk equivalent. Although this is a controversial topic, based on a single meta-analysis, as shown by the author, we cannot disregard years of accumulated evidence that diabetes is considered a CHD risk equivalent.[2-4] In a recent study among the Chinese, over a span of 15 years, it has been shown that non-heart disease–diabetic subjects had a similar risk of CV mortality as non-diabetic-heart disease subjects.[5]

The Adult Treatment Panel III (ATP) guidelines 2010, still consider Diabetes as a CHD risk equivalent.[67]

In our review, we had enlisted the risk factors associated with type 2 diabetics, who should be considered as candidates for screening for CVDs. The author of the letter has noted that the last point is not included in the risk factors to be screened, according to the latest guidelines by the American Diabetes Association (ADA). Although we appreciate his observation, we would also like to emphasize that monitoring of these risk factors should be aggressive in order to prevent coronary events in this population.

The reader has also pointed out that the ADA's latest guidelines do not recommend routine screening of CAD in all asymptomatic diabetics. However, in our review, we have mentioned that screening of asymptomatic diabetics for CAD is still controversial, due to lack of prospective outcome studies supporting its utility at this point in time.

Our review was a cardiologist's perspective and our aim was to make the physician fraternity more aware of the latest screening modalities available to detect CAD at an early stage.