The DOI matches its Crossref record; 41 of the 41 references it cites were found in a registry or an index.
Detection of Silent Myocardial Ischemia in Asymptomatic Diabetic Subjects
Open accessAbstract
OBJECTIVE—To assess the prevalence and clinical predictors of silent myocardial ischemia in asymptomatic patients with type 2 diabetes and to test the effectiveness of current American Diabetes Association screening guidelines. RESEARCH DESIGN AND METHODS—In the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study, 1,123 patients with type 2 diabetes, aged 50–75 years, with no known or suspected coronary artery disease, were randomly assigned to either stress testing and 5-year clinical follow-up or to follow-up only. The prevalence of ischemia in 522 patients randomized to stress testing was assessed by adenosine technetium-99m sestamibi single-photon emission–computed tomography myocardial perfusion imaging. RESULTS—A total of 113 patients (22%) had silent ischemia, including 83 with regional myocardial perfusion abnormalities and 30 with normal perfusion but other abnormalities (i.e., adenosine-induced ST-segment depression, ventricular dilation, or rest ventricular dysfunction). Moderate or large perfusion defects were present in 33 patients. The strongest predictors for abnormal tests were abnormal Valsalva (odds ratio [OR] 5.6), male sex (2.5), and diabetes duration (5.2). Other traditional cardiac risk factors or inflammatory and prothrombotic markers were not predictive. Ischemic adenosine-induced ST-segment depression with normal perfusion (n = 21) was associated with women (OR 3.4). Selecting only patients who met American Diabetes Association guidelines would have failed to identify 41% of patients with silent ischemia. CONCLUSIONS—Silent myocardial ischemia occurs in greater than one in five asymptomatic patients with type 2 diabetes. Traditional and emerging cardiac risk factors were not associated with abnormal stress tests, although cardiac autonomic dysfunction was a strong predictor of ischemia.
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“Studies have also found that a risk factor-based approach to the initial diagnostic evaluation and subsequent follow-up for coronary artery disease fails to identify which people with type 2 diabetes will have silent ischemia on screening tests (212,213).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [212]
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“Studies have also found that a risk factor–based approach to the initial diagnostic evaluation and subsequent follow-up for coronary artery disease fails to identify which people with type 2 diabetes who will have silent ischemia on screening tests (201,202).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [201]
Experimental — accuracy not yet measuredIn the citing paper
“Studies have found that a risk factor-based approach to the initial diagnostic evaluation and subsequent follow-up for coronary artery disease fails to identify which people with type 2 diabetes will have silent ischemia on screening tests (179,180).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2023 (2023) · cites this paper as [179]
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“Autonomic neuropathy is also strongly associated with CVD in people with diabetes (130,131).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [130]
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“However, recent studies concluded that using this approach fails to identify which patients will have silent ischemia on screening tests (130,221).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [130]
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Metadata
- Authors
- Wackers, F. J. T., Young, L. H., Inzucchi, S. E., Chyun, D. A., Davey, J. A., Barrett, E. J., Taillefer, R., Wittlin, S. D., Heller, G. V., Filipchuk, N., Engel, S., Ratner, R. E., Iskandrian, A. E., & for the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Investigators
- Affiliations
- Yale University (US)
- University of Virginia (US)
- Université de Montréal (CA)
- University of Rochester Medicine (US)
- Hartford Hospital (US)
- Cardiology Consultants, Calgary, Canada
- Soundview Research Associates, Norwalk, Connecticut
- MedStar Health Research Institute (US)
- University of Alabama at Birmingham (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2004-08-01
- Volume
- 27
- Issue
- 8
- Pages
- 1954-1961
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2159222156
- Cited by
- 791
- References
- 41
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 6 · 2023: 13 · 2022: 15 · 2021: 20 · 2020: 23 · 2019: 28 · 2018: 30 · 2017: 34 · 2016: 34 · 2015: 35 · 2014: 46 · 2013: 51 · 2012: 42
- FWCI
- 50.56
- Type
- journal article
- Language
- en
- Update notices
- correction (2005-02-01)
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Yale University
- National Center for Research Resources (5-M01-RR-00044, M01RR000125, M01 RR-00125, 5 M01 RR00847, M01RR000044, M01RR000847, 5M01 RR0596)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- silent myocardial ischemia, type 2 diabetes, asymptomatic patients, coronary artery disease, stress testing, myocardial perfusion imaging, 99mTc-sestamibi, cardiac autonomic dysfunction, Valsalva maneuver, ST-segment depression, diabetes duration, cardiovascular risk factors, prevalence
- MeSH terms
- Canada, Coronary Disease, Diabetes Mellitus, Type 1, Diabetic Angiopathies, Exercise Test, Female, Humans, Male, Middle Aged, Outpatients, United States, Tomography, Emission-Computed, Single-Photon, Myocardial Ischemia, Technetium Tc 99m Sestamibi, Radiopharmaceuticals
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