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Heart Screening of Diabetics May Not Improve Outcomes

Predictive value of screening found to be small even when a large or moderate defect is discovered

TUESDAY, April 14 (HealthDay News) -- Screening type 2 diabetes patients for asymptomatic coronary artery disease does not significantly reduce the number of heart attacks or improve outcomes compared to unscreened patients, according to a study in the April 15 issue of the Journal of the American Medical Association.

Lawrence H. Young, M.D., of Yale University School of Medicine in New Haven, Conn., and colleagues randomized 1,123 patients with type 2 diabetes and no symptoms of coronary artery disease into two groups: one screened for coronary artery disease using adenosine-stress radionuclide myocardial perfusion imaging (MPI) and a second group not screened. The two groups were followed from August 2000 to September 2007 to determine the incidence of cardiac death or myocardial infarction (MI) without death.

The investigators noted that over a mean follow-up period of 4.8 years, there were eight cardiac deaths and seven MIs without death among the screened patients, and seven cardiac deaths and 10 MIs without death among non-screened patients. Among screened patients, 409 who had normal screening results and 50 who had a small MPI defect had a lower cardiac event rate (0.4 percent per year) than those with moderate or large defects (2.4 percent per year), but identifying a moderate or large defect had only a 12 percent predictive value.

"In this contemporary study population of patients with diabetes, the cardiac event rates were low and were not significantly reduced by MPI screening for myocardial ischemia over 4.8 years," the authors write.

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