Chapter 13
Screening Patients with Prediabetes and Diabetes for Cardiovascular Disease
Sabreen Ahmed,
Saritha Tirumalasetty,
Vivian Fonseca,
Sabreen Ahmed
Section of Endocrinology, Tulane University School of Medicine, New Orleans, LA, USA
Search for more papers by this authorSaritha Tirumalasetty
Section of Endocrinology, Tulane University School of Medicine, New Orleans, LA, USA
Search for more papers by this authorVivian Fonseca
Section of Endocrinology, Tulane University School of Medicine, New Orleans, LA, USA
Search for more papers by this authorSabreen Ahmed,
Saritha Tirumalasetty,
Vivian Fonseca,
Sabreen Ahmed
Section of Endocrinology, Tulane University School of Medicine, New Orleans, LA, USA
Search for more papers by this authorSaritha Tirumalasetty
Section of Endocrinology, Tulane University School of Medicine, New Orleans, LA, USA
Search for more papers by this authorVivian Fonseca
Section of Endocrinology, Tulane University School of Medicine, New Orleans, LA, USA
Search for more papers by this authorBook Editor(s):Adrian Vella MD FRCP(Edin.),
Adrian Vella MD FRCP(Edin.)
Division of Diabetes, Endocrinology & Metabolism, Earl and Annette R. McDonough Professor, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorFirst published: 05 November 2021
Summary
Patients with dysglycemia are at risk of developing cardiovascular disease before and after the development of overt diabetes. Patients with prediabetes in the San Antonio Heart Study had atherogenic risk factors suggesting that risk for cardiovascular disease (CVD) may start before the diagnosis of diabetes. This chapter discusses optimal identification of patients at risk, current recommendations for such identification, recent developments, and possible future directions in such efforts. Possible utility in screening for cardiovascular disease may influence prevention treatments and determining risk for CVD events. Several risk factors have been associated with CVD. Individuals with diabetes have increased risk of cardiovascular disease even when hyperglycemia is controlled. Risk calculators have been used to stratify patients with CVD risk factors. Specifically in patients with diabetes, risk models developed in the past are derived from data from the United Kingdom Prospective Diabetes Study which dates back to populations of the UK in the 1970s.
References
- World Health Organization . Cardiovascular Disease (CVDs) . https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds ) (accessed 29 September 2020).
- Heart disease and stroke statistics-2019 update: a report from the American Heart Association . Circulation . 2019 ; 139 ( 10 ): e56 – e528 .
- Buse JB , Ginsberg HN , Bakris GL et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association . Diabetes Care . 2007 ; 30 ( 1 ): 162 – 172 .
- Expert Committee on the Diagnosis and Classification of Diabetes Mellitus . Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus . Diabetes Care . 1997 ; 20 ( 7 ): 1183 – 1197 .
- American Diabetes Association . Standards of medical care in diabetes – 2010 [published correction appears in Diabetes Care . 2010;33(3):692] . Diabetes Care . 2010 ; 33 ( Suppl 1 ): S11 – S61 .
- Pasquel FJ , Gregg EW , Ali MK . The evolving epidemiology of atherosclerotic cardiovascular disease in people with diabetes . Endocinol Metab Clin N Am . 2018 ; 47 ( 1 ): 1 – 32 .
- Haffner SM , Stern MP , Hazuda HP et al. Cardiovascular risk factors in confirmed prediabetic individuals: does the clock for coronary heart disease start ticking before onset of clinical diabetes? JAMA . 1990 ; 263 ( 21 ): 2893 – 2898 .
- Haffner SM , Lehto S , Ronnemaa T et al. Mortality from coronary heart disease in subjects 0with type 2 diabetes mellitus and in nondiabetic subjects with and without prior myocardial infarction . N Engl J Med . 1998 ; 339 ( 4 ): 229 – 234 .
- American Diabetes Association . 10. Cardiovascular disease and risk management: standards of medical care in diabetes – 2020 . Diabetes Care . 2020 ; 43 ( Suppl 1 ): S111 – S134 .
- Arnett DK , Blumenthal RS , Albert MA et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines . J Am Coll Cardiol . 2019 ; 74 ( 10 ): 1376 – 1414 .
- Budoff MJ , Raggi P , Beller GA et al. Noninvasive cardiovascular risk assessment of the asymptomatic diabetic patient: the Imaging Council of the American College of Cardiology . JACC Cardiovasc Imaging . 2016 ; 9 ( 2 ): 176 – 192 .
- Wackers FJ , Chyun DA , Young LH et al. Resolution of asymptomatic myocardial ischemia in patients with type 2 diabetes in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study . Diabetes Care . 2007 ; 30 ( 11 ): 2892 – 2898 .
- Young LH , Wackers FJ , Chyun DA et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial . JAMA . 2009 ; 301 ( 15 ), 1547 – 1555 . 2009.
- Boden WE , O'Rourke RA , Teo KK et al. COURAGE Trial Research Group . Optimal medical therapy with or without PCI for stable coronary disease . N Engl J Med . 2007 ; 356 : 1503 – 1516 .
- BARI 2D Study Group , Frye RL , August P et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease . N Engl J Med . 2009 ; 360 : 2503 – 2515 .
- The Decode Study Group . Is the current definition for diabetes relevant to mortality risk from all causes and cardiovascular and noncardiovascular disease . Diabetes Care . 2003 ; 26 ( 3 ): 688 – 696 .
- Norhammer A , Tenerz A , Nilsson G et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study . Lancet . 2002 ; 359 ( 9324 ): 2140 – 2144 .
- The Diabetes Control and Complications Trial Research Group . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus . N Engl J Med . 1993 ; 329 ( 14 ): 977 – 986 .
- UK Prospective Diabetes Study (UKPDS) Group . Intensive blood sugar control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) . Lancet . 1998 ; 352 : 837 – 853 .
- The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group . Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes . N Engl J Med . 2005 ; 353 ( 25 ): 2643 – 2653 .
- Holman RR , Paul SK , Bethel AM et al. 10-year follow-up of intensive glucose control in type 2 diabetes . N Engl J Med . 2008 ; 359 ( 15 ): 1577 – 1589 .
- Yusuf S , Hawken S , Ounpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the interheart study):case-control study . Lancet . 2004 ; 364 ( 9438 ): 937 – 952 .
- Gaede P , Vedel P , Larsen N et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes . N Engl J Med . 2003 ; 348 ( 5 ): 383 – 393 .
- Lind M , Svensson AM , Kosiborod M et al. Glycemic control and excess mortality in type 1 diabetes . N Engl J Med . 2014 ; 371 : 1972 – 1982 .
- Rawshani A , Rawshani A , Sattar N et al. Relative prognostic importance and optimal levels of risk factors for mortality and cardiovascular outcomes in type 1 diabetes mellitus . Circulation . 2019 ; 139 ( 16 ): 1900 – 1912 .
- Gerstein HC , Mann JF , Yi Q et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals . JAMA . 2001 ; 286 ( 4 ): 421 – 426 .
- Heart Outcomes Prevention Evaluation Study Investigators . Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy . Lancet . 2000 ; 355 : 253 – 259 .
- Fonseca V , Desouza C , Asnani S et al. Nontraditional risk factors for cardiovascular disease in diabetes . Endocrine Reviews . 2004 ; 25 ( 1 ): 153 – 175 .
- Raggi , P , Shaw LJ , Berman DS et al. Prognostic value of coronary artery calcium screening in subjects with and without diabetes . J Am Coll Cardiol . 2004 ; 43 ( 9 ): 1663 – 1669 .
- Elkeles RS , Godsland IF , Feher MD et al. Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study . Eur Heart J . 2008 ; 29 ( 18 ): 2244 – 2251 .
- Malik , S , Budoff MJ , Katz R et al. Impact of subclinical atherosclerosis on cardiovascular disease events in individuals with metabolic syndrome and diabetes: the multi-ethnic study of atherosclerosis . Diabetes Care . 2011 ; 34 ( 10 ): 2285 – 2290 .
- Malik , S , Zhao Y , Budoff M et al. Coronary artery calcium score for long-term risk classification in individuals with type 2 diabetes and metabolic syndrome from the multi-ethnic study of atherosclerosis . JAMA Cardiol . 2017 ; 2 ( 12 ): 1332 – 1340 .
- Muhlestein JB , Lappé DL , Lima JAC et al. Effect of screening for coronary artery disease using ct angiography on mortality and cardiac events in high-risk patients with diabetes: the FACTOR-64 randomized clinical trial . JAMA . 2014 ; 312 ( 21 ): 2234 – 2243 .
- Miller JM , Rochitte CE , Dewey M et al. Diagnostic performance of coronary angiography by 64-row CT . N Engl J Med . 2008 ; 359 : 2324 – 2336 .
- Kang SH , Park G-M , Lee S-W et al. Long-term prognostic value of coronary ct angiography in asymptomatic type 2 diabetes mellitus . JACC. Cardiovascular Imaging . 2016 ; 9 ( 11 ): 1292 – 1300 .
- Andreini D , Pontone G , Mushtaq S et al. Prognostic value of multidetector computed tomography coronary angiography in diabetes . Diabetes Care . 2013 ; 36 ( 7 ): 1834 – 1841 .
- Blanke P , Naoum C , Ahmadi A et al. Long-term prognostic utility of coronary ct angiography in stable patients with diabetes mellitus . JACC. Cardiovascular Imaging . 2016 ; 9 ( 11 ): 1289 – 1291 .
- Werkhoven JMV , Cademartiri F , Seitun S et al. Diabetes: prognostic value of CT coronary angiography – comparison with a nondiabetic population . Radiology . 2010 ; 256 ( 1 ): 83 – 92 .
- Min , JK , Labounty TM , Gomez MJ et al. Incremental prognostic value of coronary computed tomographic angiography over coronary artery calcium score for risk prediction of major adverse cardiac events in asymptomatic diabetic individuals . Atherosclerosis . 2014 ; 232 ( 2 ): 298 – 304 .
- Lièvre , MM , Moulin P , Thivolet C et al. Detection of silent myocardial ischemia in asymptomatic patients with diabetes: results of a randomized trial and meta-analysis assessing the effectiveness of systematic screening . Trials . 2011 ; 12 : 23 .
- Zellweger MJ , Maraun M et al. Progression to overt or silent CAD in asymptomatic patients with diabetes mellitus at high coronary risk: main findings of the prospective multicenter BARDOT trial with a pilot randomized treatment substudy . JACC Cardiovasc Imaging . 2014 ; 7 ( 10 ): 1001 – 1010 .
- Jacqueminet S , Barthelemy O , Rouzet F et al. A randomized study comparing isotope and echocardiography stress testing in the screening of silent myocardial ischaemia in type 2 diabetic patients . Diabetes Metab . 2010 ; 36 ( 6 ): 463 – 469 .
- Faglia E , Manuela M , Antonella Q et al. Risk reduction of cardiac events by screening of unknown asymptomatic coronary artery disease in subjects with type 2 diabetes mellitus at high cardiovascular risk: an open-label randomized pilot study . Am Heart J . 2005 ; 149 ( 2 ): 1 – 6 .
- Fonseca V , Desouza C , Asnani S et al. Nontraditional risk factors for cardiovascular disease in diabetes . Endocrine Reviews . 2004 ; 25 ( 1 ): 153 – 175 .
- DeSouza CA , Shapiro LF , Clevenger CM et al. Regular aerobic exercise prevents and restores age-related declines in endothelium-dependent vasodilation in healthy men . Circulation . 2000 ; 102 ( 12 ): 1351 – 1357 .
- Dei Cas A , Khan SS , Butler J et al. Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure . JACC Heart Fail . 2014 ; 3 ( 2 ): 126 – 145 .
- Boonman-de Winter LJ , Rutten FH , Cramer MJ et al. High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes . Diabetologia . 2012 ; 55 ( 8 ): 2154 – 2162 .
- Ernande L , Audureau E , Jellis CL et al. Clinical implications of echocardiographic phenotypes of patients with diabetes mellitus . J Am Coll Cardiol . 2017 ; 70 ( 14 ): 1704 – 1716 .
- Liu JE , Robbins DC , Palmieri V et al. Association of albuminuria with systolic and diastolic left ventricular dysfunction in type 2 diabetes: the Strong Heart Study . J Am Coll Cardiol . 2003 ; 41 ( 11 ): 2022 – 2028 .
- Huelsmann M , Neuhold S , Resl M et al. PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease): a prospective randomized controlled trial . J Am Coll Cardiol . 2013 ; 62 ( 15 ): 1365 – 1372 .
- Karmali KN , Goff DC , Ning H et al. A systematic examination of the 2013 ACC/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease . J Am Coll Cardiol . 2014 ; 64 ( 10 ): 959 – 968 .
- Goff DC Jr , Lloyd-Jones DM , Bennett G et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in J Am Coll Cardiol . 2014;Jul 1; 63 (25 Pt B):3026]. J Am Coll Cardiol . 2014; 63 ( 25 Pt B ): 2935 – 2959 .
- McClelland RL , Jorgensen NW , Budoff M et al. 10-year coronary heart disease risk prediction using coronary artery calcium and traditional risk factors: derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) with validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study) . J Am Coll Cardiol . 2015 ; 66 ( 15 ): 1643 – 1653 .
- Schmermund A , Möhlenkamp S , Stang A et al. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study . Am Heart J . 2002 ; 144 ( 2 ): 212 – 218 .
- Stang A , Moebus S , Dragano N et al. Baseline recruitment and analyses of nonresponse of the Heinz Nixdorf Recall Study: identifiability of phone numbers as the major determinant of response . Eur J Epidemiol . 2005 ; 20 ( 6 ): 489 – 496 .
- Victor RG , Haley RW , Willett DL et al. The Dallas Heart Study: a population-based probability sample for the multidisciplinary study of ethnic differences in cardiovascular health . Am J Cardiol . 2004 ; 93 ( 12 ): 1473 – 1480 .
- Pylypchuk R , Wells S , Kerr A et al. Cardiovascular disease risk prediction equations in 400 000 primary care patients in New Zealand: a derivation and validation study . The Lancet . 2018 ; 391 ( 10133 ): 1897 – 1907 .
- Shao H , Fonseca V , Stoecker C et al. Novel risk engine for diabetes progression and mortality in USA. Building, Relating, Assessing, and Validating Outcomes (BRAVO) . PharmacoEconomics . 2018 ; 36 : 1125 – 1134 .
- Khera A , Budoff MJ , O'Donnell CJ et al. Astronaut Cardiovascular Health and Risk Modification (Astro-CHARM) coronary calcium atherosclerotic cardiovascular disease risk calculator . Circulation . 2018 ; 138 ( 17 ): 1819 – 1827 . doi: 10.1161/CIRCULATIONAHA.118.033505.
