When and How to Look for CVD in Asymptomatic Diabetic Patients?


Dr Dayasagar Rao V, Hyderabad    04 January 2018

  1. Degree of atherosclerosis in diabetic patients is more extensive with accelerated progression in poorly-controlled diabetes.
  2. Do all asymptomatic patients with DM need CV investigations? No. Only patients with following characteristics should be investigated further: Age >40 years; DM >10 years; more number of associated CV risk factors, in addition to DM (HT, hyperlipidemia, strong f/h/o premature CAD, smoker); DM with co-existent vascular disease in other territories (PAD, H/o stroke/carotid bruit, microalbuminuria).
  3. Should all patients suspected of CAD undergo coronary angiogram? No. Stepwise approach is desirable starting with; resting EKG (pathological Q waves), TMT - positive at low workload <5 METS, CAC score >400 AU, if high probability of CAD is present, stress MPI should be done. In those with high risk perfusion defect, area of perfusion defect >10% of LV, perfusion defects in multiple vascular territories, E/O stress-induced LV dysfunction.
  4. Those with high risk perfusion defects should be subjected to invasive coronary angiogram in asymptomatic patients with diabetes.

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