Fast Five Quiz: Type 2 Diabetes and Cardiovascular Disease Risk

Romesh Khardori, MD, PhD

Disclosures

January 14, 2021

Candidates for advanced or invasive cardiac testing include those with an abnormal resting ECG as well as those with typical or atypical cardiac symptoms (such as unexplained dyspnea or chest pain). Exercise ECG testing without or with echocardiography may be used as the initial test. Signs or symptoms of associated vascular disease, such as carotid bruits, transient ischemic attack, stroke, claudication, or peripheral artery disease, also warrant consideration of cardiac testing.

Coronary artery screening methods, such as calcium scoring, may enhance cardiovascular risk assessment in asymptomatic individuals with T2D; however, their routine use entails radiation exposure and may lead to unnecessary invasive testing, such as coronary angiography and revascularization procedures. To date, this remains an area of controversy.

Recent guidelines do not recommend routine screening of asymptomatic patients with high atherosclerotic CVD risk, in part because these high-risk patients should already be receiving intensive medical therapy, which has been shown to provide benefit similar to that of invasive revascularization. Some data suggest that silent ischemia may reverse over time, further adding to the debate regarding aggressive screening strategies in individuals with T2D.

Learn more about CVD risk assessment in patients with T2D.

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