Page 349 - fbkCardioDiabetes_2017

Cardio Diabetes Medicine 2017 325

Risk Stratification in Asymptomatic Diabetics : Role of

Selective Imaging with Cardiac CT And Myocardial

Perfusion Imaging

Dr.Avijit Lahiri,

Dr. Shreenidhi Venuraju

Dr. Ram Dhillon

British Cardiac Research Trust, St John’s Wood, London, United Kingdom

Abstract: patients.Women with type 2 diabetes are particularly
Coronary heart disease (CHD) is currently the lead- prone to developing cardiovascular complications [3] .
ing cause of death worldwide; in the presence of Diabetes has been regarded as a “coronary risk
diabetesthe risk of cardiovascular disease increases equivalent,” implying a 10-year cardiovascular risk
exponentially, and particularly effects Asian popu- of >20% for every diabetes patient. This was based
lations. The arteriosclerotic process in diabetic pa- on the landmark study by Haffner et al. (Ref 1).Thus
tients occurs earlier, is often ‘silent’, more diffuse diabetic patients without previous myocardial infarc-
and often accelerated compared to the non-diabetic tion had a high risk for myocardial infarction, as high
population. Screening and risk stratification for as- as the risk of re-infarction in a non-diabetic individ-
ymptomatic atherosclerosis in diabetic subjects has ual with previous myocardial infarction. The impact
been extensively studied in recent years. New medi- of diabetes on coronary heart disease has been ob-
cal guidelines have acknowledged the heterogeneity served in various studies, such as Whitehall, Paris
in risk and suggested that further risk stratification Prospective Study, and the Helsinki Policeman Study.
in patients with diabetes is warranted. These studies demonstrated that patients with diabe-
tes and impaired glucose tolerance have 2-4 times
Introduction: higher risk of developing cardiovascular disease than
Diabetes is an important chronic disease and its inci- the non-diabetic patient population. This and other
dence is globally increasing and thus considered as studies led to the development of aggressive risk
[1]
an epidemic . The World Health Organization (WHO) factor management even in diabetic patients without
estimated that there were 30 million people with di- known coronary disease. Multiple mechanisms ap-
abetes worldwide in 1985. This number increased to pear to be involved in the genesis of atherosclerosis,
135 million by 1995 and reached 217 million in 2005. including endothelial dysfunction, hypercoagulability,
By the year 2030 WHO predicts this number will and platelet dysfunction, with hyperglycemia being
increase to at least 366 million. This extraordinary the common trigger.
growth in type 2 diabetes is occurring equally in both
[1]
developing and developed countries . Screening of CAD in Asymptomatic Diabetic
Patient:
There is a close relationship between type 2 diabetes
and the development of coronary artery disease.CVD The prevalence of silent myocardial ischemia (SMI)
is the major cause of morbidity, mortality, and health- in diabetic population varies in different studies,
care costs for patients with diabetes. Patients with ranging from 12% to almost 57% [20, 21] .One estimate
type 2 diabetes have a two to four-fold higher risk of is that 20% of patients with diabetes have coronary
a cardiovascular event when compared with non-dia- atherosclerosis. [22]
[2]
betic patients. 25% of all patients hospitalized with However, in an asymptomatic and uncomplicated
STEMI, NSTEMI and unstable angina suffer from di- cohort of patients with type 2 diabetes, 46.3% had
abetes according to the GRACE registry. Moreover, evidence of coronary artery calcification reflective of
the progression of coronary artery disease appears coronary atherosclerosis. This variability underlines
to be more rapid when compared with non-diabetic the difficulty to have a cost-effective screening and

Cardio Diabetes Medicine