1. The report of male gender and retinopathy status improves the current consensus guidelines for the screening of myocardial ischemia in asymptomatic type 2 diabetic patients
- Author
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Minh Tuan Nguyen, Paul Valensi, K. Takbou, Emmanuel Cosson, B. Chanu, S. Balta, Unité de Recherche en Epidémiologie Nutritionnelle (UREN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Sorbonne Paris Cité (USPC)-Université Paris 13 (UP13)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut National de la Recherche Agronomique (INRA), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université Paris Nord (Paris 13)
- Subjects
Male ,Endocrinology, Diabetes and Metabolism ,[SDV]Life Sciences [q-bio] ,Myocardial Ischemia ,Medicine (miscellaneous) ,French Society of Cardiology ,030204 cardiovascular system & hematology ,Coronary Angiography ,Body Mass Index ,Coronary artery disease ,MELLITUS ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,Prevalence ,Prospective Studies ,CARDIOLOGY ,Nutrition and Dietetics ,Diabetes ,ASSOCIATION ,Middle Aged ,3. Good health ,ALFEDIAM ,Practice Guidelines as Topic ,CORONARY-ARTERY-DISEASE ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Retinopathy ,SILENT ,medicine.medical_specialty ,DIAD ,030209 endocrinology & metabolism ,Guidelines ,Asymptomatic ,Risk Assessment ,03 medical and health sciences ,Sex Factors ,Internal medicine ,Diabetes mellitus ,mental disorders ,medicine ,Humans ,COMPUTED-TOMOGRAPHY ,Silent myocardial ischemia ,Risk factor ,Male gender ,Aged ,Diabetic Retinopathy ,business.industry ,Odds ratio ,medicine.disease ,Confidence interval ,Surgery ,Logistic Models ,Diabetes Mellitus, Type 2 ,Asymptomatic Diseases ,RISK-FACTORS ,American Diabetes Association ,Cardiac radionuclide imaging guidelines ,business ,TASK-FORCE - Abstract
International audience; Background and aims: American Diabetes Association (ADA), French-speaking Societies for diabetes & cardiology (ALFEDIAM-SFC) and Cardiac Radionuclide Imaging (CRI) have proposed guidelines for the screening of silent myocardial ischemia (SMI). The aim of the study was to evaluate their diagnostic values and how to improve them. Methods and results: 731 consecutive type 2 diabetic patients with >= 1 additional risk factor were screened between 1992 and 2006 for SMI by stress myocardial scintigraphy and for silent coronary artery disease (CAD) by coronary angiography. A total of 215 (29.4%) patients had SMI, and 79 of them had CAD. ADA (Odds Ratio 1.7 [95% Confidence Interval: 1.2-2.5]; p < 0.05), ALFEDIAM-SFC (OR 1.5 [1.0-2.5], p < 0.05) and CRI criteria (OR 2.0 [1.4-2.8], p < 0.01) predicted SMI. Considering the presence of male gender and retinopathy added to the prediction of SMI allowed by ADA criteria (c statistic: area under the curve AROC 0.651 [0.605-0.697] versus 0.582 [0.534-0.630]), p < 0.01 and ALFEDIAM-SFC criteria (AROC 0.672 [0.620-0.719] versus 0.620 [0.571-0.670], p < 0.05). CRI prediction of SMI was improved by considering the presence of macroproteinuria and retinopathy (AROC 0.621 [0.575-0.667] versus 0.594 [0.548-0.641], p < 0.01). Severe retinopathy (OR 3.4 [1.2-9.4], p < 0.05), smoking habits(OR 2.1 [1.1-4.2], p < 0.05) and triglyceride levels (OR 1.3 [1.0-1.6], p < 0.05) were independent predictors of CAD in the patients with SMI. Conclusion: Current guidelines criteria are able to predict SMI but prediction may be improved by considering male gender and the presence of retinopathy. CAD is more frequent in the patients with SMI who are current smokers, have severe retinopathy and higher triglyceride levels. (C) 2012 Elsevier B.V. All rights reserved.
- Published
- 2011