TY - JOUR
T1 - Stratifying cardiovascular risk in diabetes
T2 - The role of diabetes-related clinical characteristics and imaging
AU - Kianoush, Sina
AU - Al Rifai, Mahmoud
AU - Whelton, Seamus P.
AU - Shaya, Gabriel E.
AU - Bush, Aaron L.
AU - Graham, Garth
AU - Wong, Nathan D.
AU - Blaha, Michael J.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - 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.
AB - 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.
KW - Cardiovascular disease
KW - Coronary artery calcium
KW - Coronary heart disease
KW - Primary prevention
KW - Risk assessment
KW - Statins
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U2 - 10.1016/j.jdiacomp.2016.04.021
DO - 10.1016/j.jdiacomp.2016.04.021
M3 - Review article
C2 - 27179751
AN - SCOPUS:84970016145
SN - 1056-8727
VL - 30
SP - 1408
EP - 1415
JO - Journal of Diabetes and its Complications
JF - Journal of Diabetes and its Complications
IS - 7
ER -