Indian Journal of Endocrinology and Metabolism

: 2012  |  Volume : 16  |  Issue : 3  |  Page : 472--473

Authors' reply

Sandeep Chopra1, Soumia Peter2,  
1 Department of Cardiology, Christian Medical College and Hospital, Ludhiana, India
2 Department of Medicine, Christian Medical College and Hospital, Ludhiana, India

Correspondence Address:
Sandeep Chopra
Department of Cardiology, Christian Medical College and Hospital, Ludhiana

How to cite this article:
Chopra S, Peter S. Authors' reply.Indian J Endocr Metab 2012;16:472-473

How to cite this URL:
Chopra S, Peter S. Authors' reply. Indian J Endocr Metab [serial online] 2012 [cited 2021 Apr 12 ];16:472-473
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Full Text


This is in response to the queries raised about the review, 'The screening of Coronary Artery Disease in patients with type 2 diabetes mellitus - An evidence based review.' We appreciate the comments expressed by the author, however, we would like to point out the following observations.

It is an undisputed fact that diabetes mellitus (DM) predisposes to cardiovascular diseases (CVDs). Diabetic patients have been reported to have a two to four-fold increased risk of both developing and dying of coronary heart disease (CHD) in comparison to non- diabetics. [1]

The author of the letter has pointed out that type 2 diabetes is no longer considered as a CHD risk equivalent. Although this is a controversial topic, based on a single meta-analysis, as shown by the author, we cannot disregard years of accumulated evidence that diabetes is considered a CHD risk equivalent. [2],[3],[4] In a recent study among the Chinese, over a span of 15 years, it has been shown that non-heart disease-diabetic subjects had a similar risk of CV mortality as non-diabetic-heart disease subjects. [5]

The Adult Treatment Panel III (ATP) guidelines 2010, still consider Diabetes as a CHD risk equivalent. [6],[7]

In our review, we had enlisted the risk factors associated with type 2 diabetics, who should be considered as candidates for screening for CVDs. The author of the letter has noted that the last point is not included in the risk factors to be screened, according to the latest guidelines by the American Diabetes Association (ADA). Although we appreciate his observation, we would also like to emphasize that monitoring of these risk factors should be aggressive in order to prevent coronary events in this population.

The reader has also pointed out that the ADA's latest guidelines do not recommend routine screening of CAD in all asymptomatic diabetics. However, in our review, we have mentioned that screening of asymptomatic diabetics for CAD is still controversial, due to lack of prospective outcome studies supporting its utility at this point in time.

Our review was a cardiologist's perspective and our aim was to make the physician fraternity more aware of the latest screening modalities available to detect CAD at an early stage.


1Preis SR, Hwang SJ, Coady S, Pencina MJ, D'Agostino RB Sr, Savage PJ, et al. Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005. Circulation 2009;119:1728-35.
2Whiteley L, Padmanabhan S, Hole D, Isles C. Should diabetes be considered a coronary heart disease risk equivalent? Results from 25 years of follow up in the Renfrew and paisley survey. Diabetes Care 2005;28:1588-93.
3National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143.
4Juutilainen A, Lehto S, Ronnemaa T, Pyorala L, Laakso M. Type 2 Diabetes as a "Coronary Heart Disease Equivalent". An 18-year prospective population-based study in Finnish subjects. Diabetes Care 2005;28:2901-7.
5Chuang SY, Hsu PF, Sung SH, Chou P, Chen CH. Diabetes and 15 year cardiovascular mortality in a Chinese population: Differential impact of hypertension and metabolic syndrome. J Chin Med Assoc 2010;73:234-40.
6Powers AC. Diabetes Mellitus. In: Longo DL, Kasper DC, Jameson JL, Fauci AS, Hauser SL, Loscalzo JL, editors. Harrisons Principles of Internal Medicine. Vol. 2. McGraw Hill Companies; 2012. p. 2985-6.
7Dhamoon MS, Elkind MS. Inclusion of stroke as an outcome and risk equivalent in risk scores for primary and secondary prevention of vascular diseases. Circulation 2010;121:2071-8.