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Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications

Glycemic control alone does not reduce cardiovascular events in patients with type 2 diabetes (T2D), and routine screening of all T2D patients for asymptomatic coronary artery disease (CAD) is not effective for preventing acute cardiac events. We examined the effectiveness of an aggressive screening...

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Autores principales: Tsujimoto, Tetsuro, Sugiyama, Takehiro, Yamamoto-Honda, Ritsuko, Kishimoto, Miyako, Noto, Hiroshi, Morooka, Miyako, Kubota, Kazuo, Kamimura, Munehiro, Hara, Hisao, Kajio, Hiroshi, Kakei, Masafumi, Noda, Mitsuhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370783/
https://www.ncbi.nlm.nih.gov/pubmed/27537556
http://dx.doi.org/10.1097/MD.0000000000004307
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author Tsujimoto, Tetsuro
Sugiyama, Takehiro
Yamamoto-Honda, Ritsuko
Kishimoto, Miyako
Noto, Hiroshi
Morooka, Miyako
Kubota, Kazuo
Kamimura, Munehiro
Hara, Hisao
Kajio, Hiroshi
Kakei, Masafumi
Noda, Mitsuhiko
author_facet Tsujimoto, Tetsuro
Sugiyama, Takehiro
Yamamoto-Honda, Ritsuko
Kishimoto, Miyako
Noto, Hiroshi
Morooka, Miyako
Kubota, Kazuo
Kamimura, Munehiro
Hara, Hisao
Kajio, Hiroshi
Kakei, Masafumi
Noda, Mitsuhiko
author_sort Tsujimoto, Tetsuro
collection PubMed
description Glycemic control alone does not reduce cardiovascular events in patients with type 2 diabetes (T2D), and routine screening of all T2D patients for asymptomatic coronary artery disease (CAD) is not effective for preventing acute cardiac events. We examined the effectiveness of an aggressive screening protocol for asymptomatic CAD in T2D patients with advanced vascular complications. We designed a 3-year cohort study investigating the effectiveness of the aggressive coronary screening for T2D patients with advanced vascular complications and no known coronary events using propensity score adjusted analysis at a national center in Japan. Eligibility criteria included T2D without known coronary events and with any 1 of the following 4 complications: advanced diabetic retinopathy, advanced chronic kidney disease, peripheral artery disease, or cerebrovascular disease. In the aggressive screening group (n = 122), all patients received stress single photon emission computed tomography and those exhibiting myocardial perfusion abnormalities underwent coronary angiography. In the conventional screening group (n = 108), patients were examined for CAD at the discretion of their medical providers. Primary endpoint was composite outcome of cardiovascular death and nonfatal cardiovascular events. Asymptomatic CAD with ≥70% stenosis was detected in 39.3% of patients completing aggressive screening. The proportions achieving revascularization and receiving intensive medical therapy within 90 days after the screening were significantly higher in the aggressive screening group than in the conventional screening group [19.7% vs 0% (P < 0.001) and 48.4% vs 9.3% (P < 0.001), respectively]. The cumulative rate of primary composite outcome was significantly lower in the aggressive screening group according to a propensity score adjusted Cox proportional hazards model (hazard ratio, 0.35; 95% confidence interval, 0.12–0.96; P = 0.04). Aggressive coronary screening for T2D patients with advanced vascular complications reduced cardiovascular death and nonfatal cardiovascular events.
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spelling pubmed-53707832017-03-31 Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications Tsujimoto, Tetsuro Sugiyama, Takehiro Yamamoto-Honda, Ritsuko Kishimoto, Miyako Noto, Hiroshi Morooka, Miyako Kubota, Kazuo Kamimura, Munehiro Hara, Hisao Kajio, Hiroshi Kakei, Masafumi Noda, Mitsuhiko Medicine (Baltimore) 4300 Glycemic control alone does not reduce cardiovascular events in patients with type 2 diabetes (T2D), and routine screening of all T2D patients for asymptomatic coronary artery disease (CAD) is not effective for preventing acute cardiac events. We examined the effectiveness of an aggressive screening protocol for asymptomatic CAD in T2D patients with advanced vascular complications. We designed a 3-year cohort study investigating the effectiveness of the aggressive coronary screening for T2D patients with advanced vascular complications and no known coronary events using propensity score adjusted analysis at a national center in Japan. Eligibility criteria included T2D without known coronary events and with any 1 of the following 4 complications: advanced diabetic retinopathy, advanced chronic kidney disease, peripheral artery disease, or cerebrovascular disease. In the aggressive screening group (n = 122), all patients received stress single photon emission computed tomography and those exhibiting myocardial perfusion abnormalities underwent coronary angiography. In the conventional screening group (n = 108), patients were examined for CAD at the discretion of their medical providers. Primary endpoint was composite outcome of cardiovascular death and nonfatal cardiovascular events. Asymptomatic CAD with ≥70% stenosis was detected in 39.3% of patients completing aggressive screening. The proportions achieving revascularization and receiving intensive medical therapy within 90 days after the screening were significantly higher in the aggressive screening group than in the conventional screening group [19.7% vs 0% (P < 0.001) and 48.4% vs 9.3% (P < 0.001), respectively]. The cumulative rate of primary composite outcome was significantly lower in the aggressive screening group according to a propensity score adjusted Cox proportional hazards model (hazard ratio, 0.35; 95% confidence interval, 0.12–0.96; P = 0.04). Aggressive coronary screening for T2D patients with advanced vascular complications reduced cardiovascular death and nonfatal cardiovascular events. Wolters Kluwer Health 2016-08-19 /pmc/articles/PMC5370783/ /pubmed/27537556 http://dx.doi.org/10.1097/MD.0000000000004307 Text en Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 4300
Tsujimoto, Tetsuro
Sugiyama, Takehiro
Yamamoto-Honda, Ritsuko
Kishimoto, Miyako
Noto, Hiroshi
Morooka, Miyako
Kubota, Kazuo
Kamimura, Munehiro
Hara, Hisao
Kajio, Hiroshi
Kakei, Masafumi
Noda, Mitsuhiko
Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications
title Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications
title_full Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications
title_fullStr Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications
title_full_unstemmed Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications
title_short Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications
title_sort beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications
topic 4300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370783/
https://www.ncbi.nlm.nih.gov/pubmed/27537556
http://dx.doi.org/10.1097/MD.0000000000004307
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