Silent coronary artery disease and incidence of cardiovascular and mortality events at different levels of glucose regulation; results of greater than a decade follow-up

The 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD

“…A resting ECG may detect silent MI in 4% of individuals with DM, 38 which has been associated with increased risk of CVD and all-cause mortality in men but not women. 39 Additionally, prolonged corrected QT interval is associated with increased CV mortality in T1DM, whereas increasing resting heart rate is associated with risk of CVD in T1DM and T2DM. 40,41 Low heart rate variability (a marker of diabetic CV autonomic neuropathy) has been associated with an increased risk of fatal and non-fatal CAD.…”

“…A resting ECG is indicated in patients with DM diagnosed with hypertension or with suspected CVD. 38,39…”

Identification of Silent Myocardial Ischemia in Patients with Long-Term Type 1 and Type 2 Diabetes

“…Currently, the sensitivity and specificity of the exercise ECG test in the population with diabetes have been estimated at 47% and 81%, respectively [8]. According to the latest recommendations, a resting ECG is recommended in patients with diabetes and diagnosed arterial hypertension or with suspected coronary artery disease [9,10]. Assessments of the presence of atherosclerotic plaques in the ultrasound of the carotid and femoral arteries, and coronary calcification using computed tomography (CT), should be considered to assess the risk of coronary artery disease in asymptomatic patients with diabetes and moderate risk of cardiovascular disease [10].…”

Prediabetes Deserves More Attention: A Review

“…The WHO definition seeks to reduce the frequency of labeling apparently normal people as having prediabetes, but it has the disadvantage of missing some people who actually do have prediabetes. However, the ADA's lower FPG criterion has been argued to be cost-effective, since recent studies have revealed that complications of prediabetes set in even at those levels (13)(14)(15)(16)(17)(18)(19)(20).…”

“…The ADA also defines prediabetes as an A1C of 5.7-6.4%, and studies have reported metabolic derangements and complications at these levels (13)(14)(15)(16)(17)(18)(19)(20). The Canada Clinical Practice Guidelines (CPG) Expert Committee, however, pegged the diagnosis of prediabetes at an A1C of 6.0-6.4% based on a modest consensus that metabolic derangements and complications may begin to occur at such a level (20).…”