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World J Clin Cases. Sep 16, 2014; 2(9): 415-421
Published online Sep 16, 2014. doi: 10.12998/wjcc.v2.i9.415
Subclinical cardiovascular disease in type 2 diabetes mellitus: To screen or not to screen
Juan J Chillarón, Juana A Flores-Le Roux, David Benaiges, Juan Pedro-Botet
Juan J Chillarón, Juana A Flores-Le Roux, David Benaiges, Juan Pedro-Botet, Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain
Juan J Chillarón, Juana A Flores-Le Roux, David Benaiges, Juan Pedro-Botet, Institut Municipal d´Investigacions Mèdiques, Passeig Marítim 25-29, 08003 Barcelona, Spain
Juan J Chillarón, Juana A Flores-Le Roux, David Benaiges, Juan Pedro-Botet, Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Cerdanyola (NOT Sardañola) del Vallés, Barcelona, Spain
Author contributions: All the authors contributed to this paper.
Correspondence to: Dr. Juan J Chillarón, Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain. jchillaron@parcdesalutmar.cat
Telephone: +34-93-2483902 Fax: +34-93-2483337
Received: March 26, 2014
Revised: April 30, 2014
Accepted: July 12, 2014
Published online: September 16, 2014
Processing time: 182 Days and 19.8 Hours
Abstract

The prevalence of type 2 diabetes mellitus (T2DM) has risen in recent decades, and cardiovascular disease remains the leading cause of death in this population. Several clinical trials have demonstrated the benefit of tight control of risk factors on the incidence and mortality of cardiovascular disease. However, in clinical practice, few patients achieve the therapeutic goals. The current diagnostic procedures for subclinical cardiovascular disease in T2DM patients have not been shown to improve prognosis or mortality, probably because they do not categorize cardiovascular risk. Thus, clinical practice guidelines do not systematically recommend screening for subclinical atherosclerosis in these patients, although it is known that patients with extra-coronary atherosclerosis, microangiopathy and poorly-controlled cardiovascular risk factors are at high risk for cardiovascular disease. Improvements in the reliability of diagnostic tests, with fewer side effects and better cost efficiency, may better help to stratify cardiovascular risk in this group of patients, and further evaluation on this topic should be considered.

Keywords: Cardiovascular disease; Type 2 diabetes mellitus; Cardiovascular risk

Core tip: The prevalence of type 2 diabetes mellitus (T2DM) has risen in recent decades, and cardiovascular disease remains the leading cause of death in this population. Several clinical trials have demonstrated the benefit of tight control of risk factors on the incidence and mortality of cardiovascular disease. The current diagnostic procedures for subclinical cardiovascular disease in T2DM patients have not been shown to improve prognosis or mortality, probably because they do not categorize cardiovascular risk. Improvements in the reliability of diagnostic tests, with fewer side effects and better cost efficiency, may better help to stratify cardiovascular risk in this group of patients, and further evaluation on this topic should be considered.