Costly screening not routinely needed

Adults who are diagnosed with diabetes are at much higher risk for heart attack than people without diabetes, but in some cases, they lack the ability to detect the most common of warning signs: chest pain.

Chest pain, or angina, is caused by a reduction in flow of blood to the heart, called ischemia, and it’s a signal of heart attack. People who have diabetic nerve damage may not be able to feel angina, and doctors call this condition silent ischemia.

Some studies have indicated silent ischemia is common in type 2 diabetes, even as high as 60%, and doctors have been unsure whether they should routinely run expensive screening tests on their patients.

Now they have an answer. In a study involving more than 1,100 people with type 2 diabetes and no symptoms of heart disease, half received the screening test (adenosine stress myocardial perfusion imaging, or MPI) and half did not. Researchers found 22% of those screened had silent ischemia, “a far lower percentage than expected,’’ said Dr. Frans J. Wackers of Yale University School of Medicine, who led the Detection of Ischemia in Asymptomatic Diabetics study.

Study participants were on average 61 years old and had diabetes for about 8 years. They were generally overweight and only half were able to exercise. Sixty percent had two or more risk factors for heart disease.

But over the course of the study, both groups – those who got the screening and those who did not – did pretty well, and there was no difference in outcome between the groups. The rate of cardiac events was half a percent per year, and 7% in both groups had bypass surgery. Interestingly, Dr. Wackers says, during the study the percentage of patients who were given treatments such as aspirin, statins for lowering cholesterol, and blood pressure-lowering drugs rose from 40% to 75%. He suspects this treatment explains why everyone did so well.

His conclusion: The situation is not as bad as had been feared, and there's no benefit in expensive routine screening of patients who don't have cardiac symptoms. "The risk in these patients is really very low,'' he says, but people with type 2 diabetes should be followed closely, given standard clinical care and followed up with diagnostic testing and treatment as needed.

Comments

[diabetic symptoms]

thanks for good information....understanding early signs is very important