Stratifying cardiovascular risk in diabetes: The role of diabetes-related clinical characteristics and imaging

Sina Kianoush, Mahmoud Al Rifai, Seamus P. Whelton, Gabriel E. Shaya, Aaron L. Bush, Garth Graham, Nathan D. Wong, Michael J. Blaha

Research output: Contribution to journalReview articlepeer-review

Abstract

Diabetes is a major coronary heart disease (CHD) and cardiovascular disease (CVD) risk factor and has traditionally been classified as a CHD risk equivalent. CVD risk, however, is heterogeneous among diabetic patients and thus further evaluation is warranted before initiating or titrating preventive pharmacotherapy. Prognostic clinical characteristics of diabetes such as age of onset, duration, and severity of diabetes, as well as concomitant cardiometabolic factors account for much of the variability in CHD and CVD risk. This heterogeneity can also be evaluated directly using non-invasive imaging, which allows for a more individualized risk assessment in order to minimize both under and overtreatment. In this paper, we review guideline recommendations for atherosclerotic CVD risk assessment driving the use of statins or aspirin for certain subgroups of patients with diabetes. We further discuss imaging techniques, such as stress myocardial perfusion imaging, coronary computed tomography angiography, and coronary artery calcium (CAC) scoring that can guide the decision to treat high-risk patients. Among imaging tests, current guidelines consider CAC scoring the most appropriate risk stratification tool for asymptomatic individuals with diabetes that can guide initiating/intensifying or withholding the most aggressive pharmacological therapies among high-risk (CAC > 100) or low-risk (CAC = 0) individuals, respectively.

Original languageEnglish (US)
Pages (from-to)1408-1415
Number of pages8
JournalJournal of Diabetes and its Complications
Volume30
Issue number7
DOIs
StatePublished - Sep 1 2016

Keywords

  • Cardiovascular disease
  • Coronary artery calcium
  • Coronary heart disease
  • Primary prevention
  • Risk assessment
  • Statins

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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