We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes

Aaron I. Vinik, MD, PhD; Raelene E. Maser, PhD
JAMA. 2009;302(7):735-737. doi:10.1001/jama.2009.1188.
Text Size: A A A
Published online


To the Editor: Dr Young and colleagues1 reported the lack of utility of MPI for predicting myocardial events in the DIAD study. However, the article contained information that suggests a simpler and possibly more effective means of predicting cardiovascular events.

In Table 5, the age- and sex-adjusted hazard ratio for the lowest quartile of cardiac autonomic dysfunction was 4.33 (95% confidence interval, 2.14-8.75; P < .001). A previous article from this group2 reported that an autonomic function test that measures the Valsalva ratio (which incorporates cardiac parasympathetic and sympathetic nervous system activity3) was a strong predictor of myocardial ischemia (which may be silent). The study by Young et al reported results of change in heart rate from lying to standing, indicating that the presence of cardiac autonomic dysfunction had one of the highest hazard ratios associated with the primary events, greater than many of the other clinical factors. In addition, numbness and absence of sensation, which are indices of peripheral neuropathy, had hazard ratios of 2.23 and 2.83, respectively (P < .05 for both). It therefore seems that greater attention to autonomic function should be considered.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




August 19, 2009
Taishiro Chikamori, MD
JAMA. 2009;302(7):735-737. doi:10.1001/jama.2009.1187.
August 19, 2009
Mladen I. Vidovich, MD
JAMA. 2009;302(7):735-737. doi:10.1001/jama.2009.1189.
August 19, 2009
Frans J. Th. Wackers, MD, PhD; Lawrence H. Young, MD
JAMA. 2009;302(7):735-737. doi:10.1001/jama.2009.1190.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.