Beruflich Dokumente
Kultur Dokumente
Frans J Th Wackers, MD
IAD
D
Diabetes Mellitus
• Risk Factor for Coronary Artery Disease (CAD)
• Heart Attacks, Cardiac Death 2-4 x more often
• Cause of Death: 65 % Cardiovascular
• CAD often Unrecognized
No Angina
Silent Heart Attacks
Sudden Cardiac Death
Already Advanced Before Symptoms
A D
DI
Principal
Principal Investigators
Investigators
Frans
FransJ. J. Th.
Th. Wackers,
Wackers,MDMD
Deborah
DeborahChyun,Chyun,RN,
RN,MSN,
MSN, PhD
PhD
Silvio
Silvio Inzucchi,
Inzucchi,MDMD
Lawrence
Lawrence Young,
Young, MD
MD
Jan
Jan Davey,
Davey,RN, RN, MSN
MSN Wackers et al. Diabetes Care 27; 1954-1961, 2004
Goals of DIAD Study
In Asymptomatic Pts with Type 2 Diabetes:
1. What is Prevalence of
Silent Heart Disease on Screening?
2. Do Results of Screening
Predict Outcomes?
• Type 2 Diabetes
• Age 50-75 Yrs
• No Known Heart Disease
• Normal Electrocardiogram
• No Prior Testing within 3 Yrs
Jul 2000 - Aug 2002
1,123 Pts Randomized
defect
Stress
Rest
Normal
409 (78%)
Abnormal
113 (22%)
Abnormal Screening
• Small defect 10 %
• Moderate-Large defect 6 %
• Nonperfusion (ECG) 6%
Wackers et al. Diabetes Care 27; 1954-1961, 2004
Subsequent Clinical Care
Both Randomized Groups:
Screening
No Screening
0.04
3.0 %
2.7 %
0.02
Log-rank
P = NS
0
0 1 2 3 4 5
Years
Cardiac Death and Heart Attacks: Screening Results
Cumulative Incidence Cardiac Events 0.16
Normal
Small defect
0.14 Moderate or large defect
12.1 %
Nonperfusion abnormality (ECG)
0.12
0.10
0.08
6.7 %
0.06
Log-rank
0.04 P = .005
2.0 %
0.02
2.0 %
0
0 1 2 3 4 5
Years
Primary End Points (5-Yr)
Screening No Screening
n = 561 n = 562 p
Screening No Screening
n = 561 n = 562 p
Screening No Screening
n = 561 n = 562 p
Non-Protocol
Stress Tests 118 (21%) 170 (30%) 0.0005
80
* * * *
60
% patients
40
20
Aspirin Statin ACE Anti-HTN
0
0 5 0 5 0 5 0 5 Year in
Study
Screening No Screening p < 0.001
Asymptomatic Pts with
Type 2 Diabetes Mellitus:
- Truly Asymptomatic
- Normal Rest ECG