@@112058@@ : It is not yet the time to stop screening diabetic patients for silent myocardial ischaemia

@@110897@@ @@107387b@@ dimanche 19 mai 2013

Diabetes & Metabolism
Volume 36, n° 2
pages 91-96 (avril 2010)

Doi : 10.1016/j.diabet.2010.01.001

Received : 13 December 2009 ; accepted : 18 January 2010

Reviews

It is not yet the time to stop screening diabetic patients for silent myocardial ischaemia
Le temps n’est pas encore venu d’arrêter le dépistage de l’ischémie myocardique silencieuse du diabétique

P. Valensi ⁎ , E. Cosson
Department of Endocrinology–Diabetology–Nutrition, Paris-Nord University, Jean Verdier Hospital, AP–HP, avenue du 14-juillet, 93143 Bondy cedex, France

Corresponding author.


	Abstract

Despite the intensified control of risk factors, silent myocardial ischaemia (SMI) is still a frequent complication of diabetes that is also associated with a higher risk of cardiac events. The objectives of this review are to summarize the importance of screening for SMI in a subset of asymptomatic diabetic patients. There is evidence that screening markedly improves the evaluation of cardiovascular risk compared with the usual risk scores. New markers, validated by large-scale studies, are needed to help in identifying the patients with silent coronary stenoses, thereby lowering the number of screened patients. Some indications of benefit with revascularization in patients with silent coronary stenoses are also available. Although it is not yet time to stop screening diabetic patients for SMI, such screening should focus on patients who are at high or intermediate cardiovascular risk. Guidelines need to be updated to increase the value of screening.


	Résumé

Malgré le contrôle intensif des facteurs de risque, l’ischémie myocardique silencieuse (IMS) demeure une complication fréquente du diabète et est associée à un risque accru d’évènements cardiaques. Les objectifs de cette revue sont de résumer l’intérêt du dépistage de l’IMS dans une sous-population de diabétiques asymptomatiques. Au minimum existe la preuve que le dépistage améliore nettement l’évaluation du risque cardiovasculaire comparativement aux scores de risque usuels. De nouveaux marqueurs, validés dans de grandes études, sont nécessaires pour aider à identifier les patients avec sténoses coronaires silencieuses et réduire le nombre de patients chez qui l’IMS doit être dépistée. Quelques données suggèrent le bénéfice de la revascularisation chez les patients avec sténoses coronaires silencieuses. Le temps n’est pas encore venu d’arrêter le dépistage de l’IMS mais le dépistage doit être mieux ciblé, chez des patients à risque élevé ou intermédiaire. Les recommandations doivent être actualisées pour augmenter le rendement du dépistage.

Keywords : Diabetes, Coronary artery disease, Silent myocardial ischaemia, Cardiovascular risk, Revascularization

Mots clés : Diabète, Maladie coronaire, Ischémie myocardique silencieuse, Risque cardiovasculaire, Revascularisation

Outline

Masquer le plan

Introduction

Predictive value of silent myocardial ischaemia (+)

Are there any specific treatments and is revascularization useful? (+)

How to identify which diabetic patients to screen for silent coronary artery disease (+)

Conclusion

Conflict of interest

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