Assessment of cardiovascular risk in diabetes: Risk scores and provocative testing

Table 1 Clinical features suggesting diabetes patients at high risk

Diabetes and age > 60 yr

Diabetes and microalbuminuria (> 20 mcg/min or urine albumin to creatinine ratio > 2.5 mg/mmol for males, > 3.5 mg/mmol for females)

Diabetes and moderate or severe chronic kidney disease (persistent proteinuria or eGFR < 45 mL/min per 1.73 m2)

Diabetes and a previous diagnosis of familial hypercholesterolaemia in the individual

Diabetes and systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg

Diabetes and serum total cholesterol > 7.5 mmol/L

Albumin to creatinine ratio - confirmed on second test and not due to another cause (e.g., urinary tract infection).

Table 2 American Diabetes Association guidelines on stress testing in diabetic patients[23]

Typical or atypical cardiac symptoms

Resting electrocardiogram suggestive of ischaemia or infarction

Peripheral or carotid occlusive arterial disease

Table 3 Signs and symptoms of concern in an otherwise asymptomatic patient

Symptoms suggestive of cardiovascular autonomic neuropathy

Resting tachycardia

Postural hypotension

Signs/symptoms suggestive of coexisting vascular disease Erectile dysfunction Claudication symptoms Carotid bruit Diminished/absent peripheral pulses

Inappropriate exercise tolerance

Shortness of breath without clear pathology

Table 4 Sensitivity and specificity of provocative tests in patients with diabetes

Diagnostic test	Sensitivity (%)	Specificity (%)
Exercise stress test[33]	47	81
Stress echo[35]	82	54
Stress nuclear perfusion study[36]	86	56
CT coronary angiogram[40]	76	90
Coronary calcium score[39]	64-75	75-83

CT: Computed tomography.

Table 5 Sensitivity and specificity of provocative testing in women[44]

Diagnostic test	Sensitivity (%)	Specificity (%)
Exercise electrocardiogram	31-71	66-78
Exercise echocardiogram	80-88	79-86
Pharmacological echocardiogram	76-90	85-94
Nuclear perfusion study	78-88	64-91
Computed tomography coronary angiogram	97	79