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Screening for asymptomatic coronary artery disease in patients with diabetes mellitus: A systematic review and meta-analysis of randomized trials.

Bauters C, Lemesle G - BMC Cardiovasc Disord (2016)

Bottom Line: There was no evidence for an effect of screening on the use of statins (OR = 1.19 [0.94-1.51]), aspirin (OR = 1.02 [0.83-1.25]), or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 0.97 [0.79-1.19]).The present analysis shows no evidence for a benefit of screening diabetic patients for the presence of asymptomatic CAD.The proportion of patients who undergo myocardial revascularization as a consequence of screening was low.

View Article: PubMed Central - PubMed

Affiliation: Centre Hospitalier Régional et Universitaire de Lille, Lille, France. christophe.bauters@chru-lille.fr.

ABSTRACT

Background: Screening diabetic patients for the presence of asymptomatic coronary artery disease (CAD) may potentially impact therapeutic management and outcome. We performed a systematic review and meta-analysis of randomized trials addressing this question.

Methods: We searched the PubMed database for studies reporting a randomized comparison of systematic screening for CAD in diabetic patients versus no systematic screening. The screening protocols were variable with the use of exercise electrocardiogram test, or stress echocardiography, or nuclear test, or coronary computed tomography angiography.

Results: The final analysis included 5 randomized studies and 3,314 patients altogether. The screening strategy had no detectable impact on outcome with odds ratios (OR) [95 % confidence interval (CI)] of 1.00 [0.67-1.50], 0.72 [0.33-1.57], 0.71 [0.40-1.27], and 0.60 [0.23-1.52] for all-cause death, cardiovascular death, non-fatal myocardial infarction, and the composite cardiovascular death or non-fatal myocardial infarction, respectively. Protocol-related coronary procedures were relatively infrequent in screened patients: coronary angiography was performed in 8 % of the cases, percutaneous coronary intervention in 2.5 %, and coronary artery bypass surgery in 1.5 %. There was no evidence for an effect of screening on the use of statins (OR = 1.19 [0.94-1.51]), aspirin (OR = 1.02 [0.83-1.25]), or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 0.97 [0.79-1.19]).

Conclusion: The present analysis shows no evidence for a benefit of screening diabetic patients for the presence of asymptomatic CAD. The proportion of patients who undergo myocardial revascularization as a consequence of screening was low.

No MeSH data available.


Related in: MedlinePlus

Effect of screening on statin, aspirin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE/ARB) use
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Fig4: Effect of screening on statin, aspirin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE/ARB) use

Mentions: Information on statins use after screening was available in all five studies. As shown in Fig. 4, there was no evidence in the pooled analysis for an increased use of statins in screened patients (OR = 1.19 [0.94–1.51] (P = 0.158). Information on aspirin use after screening was available in 4 studies. Likewise, as shown in Fig. 4, there was no evidence for an increased use of aspirin in screened patients (OR = 1.02 [0.83–1.25] (P = 0.837). Information on ACE/ARB use after screening was available in three studies. Likewise, as shown in Fig. 4, there was no evidence for an increased use of ACE/ARB in screened patients (OR = 0.97 [0.79–1.19] (P = 0.780).Fig. 4


Screening for asymptomatic coronary artery disease in patients with diabetes mellitus: A systematic review and meta-analysis of randomized trials.

Bauters C, Lemesle G - BMC Cardiovasc Disord (2016)

Effect of screening on statin, aspirin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE/ARB) use
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4862116&req=5

Fig4: Effect of screening on statin, aspirin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE/ARB) use
Mentions: Information on statins use after screening was available in all five studies. As shown in Fig. 4, there was no evidence in the pooled analysis for an increased use of statins in screened patients (OR = 1.19 [0.94–1.51] (P = 0.158). Information on aspirin use after screening was available in 4 studies. Likewise, as shown in Fig. 4, there was no evidence for an increased use of aspirin in screened patients (OR = 1.02 [0.83–1.25] (P = 0.837). Information on ACE/ARB use after screening was available in three studies. Likewise, as shown in Fig. 4, there was no evidence for an increased use of ACE/ARB in screened patients (OR = 0.97 [0.79–1.19] (P = 0.780).Fig. 4

Bottom Line: There was no evidence for an effect of screening on the use of statins (OR = 1.19 [0.94-1.51]), aspirin (OR = 1.02 [0.83-1.25]), or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 0.97 [0.79-1.19]).The present analysis shows no evidence for a benefit of screening diabetic patients for the presence of asymptomatic CAD.The proportion of patients who undergo myocardial revascularization as a consequence of screening was low.

View Article: PubMed Central - PubMed

Affiliation: Centre Hospitalier Régional et Universitaire de Lille, Lille, France. christophe.bauters@chru-lille.fr.

ABSTRACT

Background: Screening diabetic patients for the presence of asymptomatic coronary artery disease (CAD) may potentially impact therapeutic management and outcome. We performed a systematic review and meta-analysis of randomized trials addressing this question.

Methods: We searched the PubMed database for studies reporting a randomized comparison of systematic screening for CAD in diabetic patients versus no systematic screening. The screening protocols were variable with the use of exercise electrocardiogram test, or stress echocardiography, or nuclear test, or coronary computed tomography angiography.

Results: The final analysis included 5 randomized studies and 3,314 patients altogether. The screening strategy had no detectable impact on outcome with odds ratios (OR) [95 % confidence interval (CI)] of 1.00 [0.67-1.50], 0.72 [0.33-1.57], 0.71 [0.40-1.27], and 0.60 [0.23-1.52] for all-cause death, cardiovascular death, non-fatal myocardial infarction, and the composite cardiovascular death or non-fatal myocardial infarction, respectively. Protocol-related coronary procedures were relatively infrequent in screened patients: coronary angiography was performed in 8 % of the cases, percutaneous coronary intervention in 2.5 %, and coronary artery bypass surgery in 1.5 %. There was no evidence for an effect of screening on the use of statins (OR = 1.19 [0.94-1.51]), aspirin (OR = 1.02 [0.83-1.25]), or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 0.97 [0.79-1.19]).

Conclusion: The present analysis shows no evidence for a benefit of screening diabetic patients for the presence of asymptomatic CAD. The proportion of patients who undergo myocardial revascularization as a consequence of screening was low.

No MeSH data available.


Related in: MedlinePlus