To the Editor: Dr Young and colleagues1 reported the results of the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study. This trial addressed whether routine screening of patients with asymptomatic type 2 diabetes for coronary artery disease (CAD) with myocardial perfusion imaging (MPI) is warranted. Among 1123 patients, the primary outcome of cardiac death or nonfatal myocardial infarction occurred in 15 patients in the screening group and in 17 patients in the no-screening group during the mean follow-up of 4.8 years (P = .73). The low-risk nature of the study population is one possible explanation for the negative results of the DIAD study, which had a low rate of high-risk MPI results and low cardiac event rates. However, in a clinical practice setting the presence of advanced CAD in asymptomatic diabetic patients is common, and the prognosis of patients with type 2 diabetes is poor.2
The identification of a higher-risk group of diabetic patients in comparison with the DIAD study population using a simple and inexpensive test would be valuable. Among clinical factors associated with primary outcomes in the DIAD study, peripheral artery disease (PAD) was one of the strongest predictors.1 Previous studies also reported a high prevalence of asymptomatic CAD in patients with PAD.3 - 4 Because PAD is common in patients with diabetes and is easily detected by measuring the ankle-brachial blood pressure index, a subanalysis focused on the relation of the ankle-brachial blood pressure index with MPI results and subsequent prognosis may be of value.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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