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In Reply: Dr Chikamori suggests that the lack of beneficial effect of screening was due in part to the low-risk nature of the DIAD participants. We excluded patients who had symptoms of angina, a history of CAD, a recent stress test, or an abnormal rest electrocardiogram. Those patients are indeed at high risk and require diagnostic cardiac evaluation. However, DIAD focused on asymptomatic diabetic patients and addressed the efficacy of screening these patients for inducible ischemia.

Previous investigations, such as the J-ACCESS¹ and Mayo Clinic² studies, showed a higher prevalence of inducible ischemia and greater cardiac risk. However, the former included symptomatic patients and the second was a retrospective database analysis. In both studies patients were referred for testing by their physicians. Such patients are often selected for cardiac testing because of physician concern for particularly high cardiac risk or preoperative evaluation. Both studies also included patients with a prior . . . [Full Text of this Article]

Frans J. Th. Wackers, MD, PhD
frans.wackers@yale.edu

Lawrence H. Young, MD
Section of Cardiovascular Medicine
Yale University School of Medicine
New Haven, Connecticut

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RELATED ARTICLE

Cardiac Outcomes After Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes: The DIAD Study: A Randomized Controlled Trial
Lawrence H. Young, Frans J. Th. Wackers, Deborah A. Chyun, Janice A. Davey, Eugene J. Barrett, Raymond Taillefer, Gary V. Heller, Ami E. Iskandrian, Steven D. Wittlin, Neil Filipchuk, Robert E. Ratner, Silvio E. Inzucchi, and for the DIAD Investigators
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Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes
Taishiro Chikamori
JAMA. 2009;302(7):735.
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Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes
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Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes
Mladen I. Vidovich
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