Individuals with diabetes have high mortality because of CVD, yet many of them are still suboptimally treated for CVD risk factors 59. Besides, the heterogeneity in CVD risk among individuals with DM calls for individualized risk assessment before further tailored management is implemented. Although current screening methods have been demonstrated to be effective in predicting future coronary events, the following points need to be addressed: (i) only a few studies have been conducted on the cost-effectiveness of various scanning modalities. Acampa et al.60 calculated the cost per net reclassification index change of MPI scanning to be $880.80, but they did not specify whether this number was cost-saving or not. A promising outcome may promote the utility of screening in a wider variety of patient groups if covered by insurance. (ii) Large randomized clinical trials should be designed to directly look into the impact of screening tests on clinical outcomes, as well as the impact on downstream clinical decisions, risk factor changes, and total savings. (iii) Seldom have screening methods been directly compared for predictive efficacy using the hazard ratio from Cox regression, the C-statistic, numbers need-ed to treat, or the net reclassification index in models; this evidence will be the most powerful for demonstrating screening preference in DM patients. In the future, many more novel screening methods will be investigated and may provide better solutions to the problem of CVD risk assessment in patients with diabetes.
Dr Wong is a consultant for Re-Engineering Healthcare. Dr. Zhao has no conflict of interest.
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