Five-year outcomes in high-risk participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study

A post hoc analysis

Shanti Bansal, Frans J Th Wackers, Silvio E. Inzucchi, Deborah Chyun, Janice A. Davey, Lawrence H. Staib, Lawrence H. Young

Research output: Contribution to journalArticle

Abstract

OBJECTIVE - To estimate baseline cardiovascular risk of 1,123 participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study and to assess cardiac event rates and the effect of screening on outcomes in these higher-risk participants. RESEARCH DESIGN AND METHODS - Baseline cardiovascular risk was assessed using four established methods: Framingham score, UK Prospective Diabetes Study (UKPDS) risk engine, criteria of the French-Speaking Association for the Study of Diabetes and Metabolic Diseases, and the presence or absence of metabolic syndrome. Cardiac events (cardiac death or nonfatal myocardial infarction) were assessed during the 4.8-year follow-up in participants with intermediate/high cardiovascular risk. RESULTS - By various risk-stratification approaches, 53-75% of participants were defined as having intermediate or high cardiovascular risk. The prevalence of inducible ischemia on screening in these individuals ranged from 21 to 24%, similar to lower-risk participants (19-23%). Cardiac event rates were greater in intermediate-/high- risk versus low-risk groups, but this was only significant for the UKPDS risk engine (4.2 vs. 1.2%, P=0.002). The annual cardiac event rate was <1% in all risk groups, except in the high-risk UKPDS group (∼2% per year). In intermediate-/high-risk participants randomized to screening versus no screening, 4.8-year cardiac event rates were similar (2.5-4.8% vs. 3.1-3.7%). CONCLUSIONS - A substantial portion of the DIAD population was defined as having intermediate/high baseline cardiovascular risk. Nevertheless, their annual cardiac event rate was low and not altered by routine screening for inducible ischemia.

Original languageEnglish (US)
Pages (from-to)204-209
Number of pages6
JournalDiabetes Care
Volume34
Issue number1
DOIs
StatePublished - Jan 2011

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Ischemia
Prospective Studies
Metabolic Diseases
Research Design
Myocardial Infarction

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Five-year outcomes in high-risk participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study : A post hoc analysis. / Bansal, Shanti; Wackers, Frans J Th; Inzucchi, Silvio E.; Chyun, Deborah; Davey, Janice A.; Staib, Lawrence H.; Young, Lawrence H.

In: Diabetes Care, Vol. 34, No. 1, 01.2011, p. 204-209.

Research output: Contribution to journalArticle

Bansal, Shanti ; Wackers, Frans J Th ; Inzucchi, Silvio E. ; Chyun, Deborah ; Davey, Janice A. ; Staib, Lawrence H. ; Young, Lawrence H. / Five-year outcomes in high-risk participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study : A post hoc analysis. In: Diabetes Care. 2011 ; Vol. 34, No. 1. pp. 204-209.
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abstract = "OBJECTIVE - To estimate baseline cardiovascular risk of 1,123 participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study and to assess cardiac event rates and the effect of screening on outcomes in these higher-risk participants. RESEARCH DESIGN AND METHODS - Baseline cardiovascular risk was assessed using four established methods: Framingham score, UK Prospective Diabetes Study (UKPDS) risk engine, criteria of the French-Speaking Association for the Study of Diabetes and Metabolic Diseases, and the presence or absence of metabolic syndrome. Cardiac events (cardiac death or nonfatal myocardial infarction) were assessed during the 4.8-year follow-up in participants with intermediate/high cardiovascular risk. RESULTS - By various risk-stratification approaches, 53-75{\%} of participants were defined as having intermediate or high cardiovascular risk. The prevalence of inducible ischemia on screening in these individuals ranged from 21 to 24{\%}, similar to lower-risk participants (19-23{\%}). Cardiac event rates were greater in intermediate-/high- risk versus low-risk groups, but this was only significant for the UKPDS risk engine (4.2 vs. 1.2{\%}, P=0.002). The annual cardiac event rate was <1{\%} in all risk groups, except in the high-risk UKPDS group (∼2{\%} per year). In intermediate-/high-risk participants randomized to screening versus no screening, 4.8-year cardiac event rates were similar (2.5-4.8{\%} vs. 3.1-3.7{\%}). CONCLUSIONS - A substantial portion of the DIAD population was defined as having intermediate/high baseline cardiovascular risk. Nevertheless, their annual cardiac event rate was low and not altered by routine screening for inducible ischemia.",
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AB - OBJECTIVE - To estimate baseline cardiovascular risk of 1,123 participants in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study and to assess cardiac event rates and the effect of screening on outcomes in these higher-risk participants. RESEARCH DESIGN AND METHODS - Baseline cardiovascular risk was assessed using four established methods: Framingham score, UK Prospective Diabetes Study (UKPDS) risk engine, criteria of the French-Speaking Association for the Study of Diabetes and Metabolic Diseases, and the presence or absence of metabolic syndrome. Cardiac events (cardiac death or nonfatal myocardial infarction) were assessed during the 4.8-year follow-up in participants with intermediate/high cardiovascular risk. RESULTS - By various risk-stratification approaches, 53-75% of participants were defined as having intermediate or high cardiovascular risk. The prevalence of inducible ischemia on screening in these individuals ranged from 21 to 24%, similar to lower-risk participants (19-23%). Cardiac event rates were greater in intermediate-/high- risk versus low-risk groups, but this was only significant for the UKPDS risk engine (4.2 vs. 1.2%, P=0.002). The annual cardiac event rate was <1% in all risk groups, except in the high-risk UKPDS group (∼2% per year). In intermediate-/high-risk participants randomized to screening versus no screening, 4.8-year cardiac event rates were similar (2.5-4.8% vs. 3.1-3.7%). CONCLUSIONS - A substantial portion of the DIAD population was defined as having intermediate/high baseline cardiovascular risk. Nevertheless, their annual cardiac event rate was low and not altered by routine screening for inducible ischemia.

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