Investigation of coronary artery disease in diabetes: is screening of asymptomatic patients necessary?

Diabetes is a major risk factor for ischaemic heart disease; the relative risk increases at least twofold among diabetic men and even more so for women. 1 Diabetes is associated with more extensive coronary artery disease and an increased risk of cardiac death. 2 Even in the absence of frank diabetes, glucose intolerance has been associated with a heightened risk of coronary artery disease independent of age, blood pressure, and other risk factors. 3 Moreover, patients with diabetes are more likely to sustain an acute myocardial infarction, 4 and in these patients diabetes is a major independent predictor of morbidity and mortality. 5 Symptomatic patients Because the prevalence of coronary artery disease is higher in diabetic than non-diabetic populations, the probability of disease in the diabetic patient with typical angina is also high.