Background: Evaluated the efficacy of reducing the risk of cardiac events by a preclinical diagnosis of CAD in subjects with type 2 diabetes mellitus with 2 or more cardiovascular risk factors. Methods: One hundred forty- one subjects with type 2 diabetes mellitus without known cardiac disease and asymptomatic, aged >45 to < 76 years, were randomized into the screening arm for CAD(71 patients) or to the control arm(70 patients). The screening consisted in performing an exercise electrocardiogram test and dipyridamole stress echocardiography; if 1 test was abnormal, coronary angiography is done. Screening was positive in 15 subjects(21.4% ). At coronary angiography, which was performed in 14 of 15 patients, stenoses ≥ 50% of vessel diameter were present in 9 patients, of these 4 underwent coronary artery bypass grafting and 4 underwent percutaneous transluminal coronary angioplasty. Stenoses < 50% of vessel diameter were present in 5 patients. Results: Mean follow- up was 53.5 months(range, 42- 54 months). During this period, 1 major(myocardial infarction) and 3 minor events(angina) occurred in the screening arm. Eleven major and 4 minor events occurred in the control arm. In the screened arm, the proportion of all events was significantly less(P=.018)(RR. 226, 95% CI 0.707- 0.719, P=.012); the proportion of major to minor events was significantly less(P=.006)(RR.07,95% CI 0.0087- 0.565, P=.013). Conclusions: The preclinical diagnosis of CAD is effective in reducing the risk of cardiac events, especially major events, in subjects with type 2 diabetes mellitus at high cardiovascular risk.
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