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JACC Cardiovasc Imaging. 2016 Feb;9(2):176-92. doi: 10.1016/j.jcmg.2015.11.011.

Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient: The Imaging Council of the American College of Cardiology.

Author information

Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California. Electronic address:
Mazankowski Alberta Heart Institute, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Medicine, University of Virginia, Charlottesville, Virginia.
Departments of Imaging and Medicine, Cedars-Sinai Medical Center and the Cedars-Sinai Heart Institute, Los Angeles, California.
Department of Cardiology, Hofstra North Shore-LIJ School of Medicine, Uniondale, New York.
Department of Medicine, University of California, Irvine, California.
Department of Medicine/Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Cardiology Division, MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Erratum in

  • JACC Cardiovasc Imaging. 2016 Mar;9(3):335.


Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a "coronary risk equivalent," implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies from different cohorts provided varying conclusions on the validity of the concept of coronary risk equivalency in patients with diabetes. New guidelines have started to acknowledge the heterogeneity in risk and include different treatment recommendations for diabetic patients without other risk factors who are considered to be at lower risk. Furthermore, guidelines have suggested that further risk stratification in patients with diabetes is warranted before universal treatment. The Imaging Council of the American College of Cardiology systematically reviewed all modalities commonly used for risk stratification in persons with diabetes mellitus and summarized the data and recommendations. This document reviews the evidence regarding the use of noninvasive testing to stratify asymptomatic patients with diabetes with regard to coronary heart disease risk and develops an algorithm for screening based on available data.


coronary CT; diabetes; echocardiography; exercise testing; nuclear imaging

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