• Yukiko Kawasaki-Ogita, Yoshiyuki Hamamoto, Sachiko Honjo, Hiroki Ikeda, Yoshiharu Wada, Kazuhiro Nomura, Yorihiro Iwasaki, Ryuji Nohara, and Hiroyuki Koshiyama.
• Center for Diabetes & Endocrinology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Japan. yk-kawasaki@kitano-hp.or.jp
• Intern. Med. 2012 Jan 1; 51 (24): 333733423337-42.

ObjectiveWe prospectively investigated the efficacy of the screening methods for asymptomatic coronary heart disease (CHD) in Japanese patients with type 2 diabetes using the treadmill tolerance test (TTT) as a first-line test or the American Diabetes Association (ADA) guidelines.MethodsThe subjects included consecutive inpatients with type 2 diabetes (n=331) assessed with both electrocardiogram (ECG) at rest and TTT. Subjects with abnormal TTT findings were evaluated using stress myocardial perfusion scintigraphy (MPS).ResultsA total of 60 out of 69 subjects with positive TTT findings underwent MPS, among whom a total of 22 subjects (6.6% of the total number of subjects) had positive MPS results. Among those with positive MPS results, a total of 14 subjects underwent coronary angiography, eight of whom were determined to have significant coronary artery stenosis. The prevalence rates of hypertension and micro/macroalbuminuria were significantly higher in the MPS-positive group (77.3% and 54.5%, respectively) than in the TTT-negative group (44.7% and 27.1%, respectively). Among the subjects with positive MPS results, 68.2% met the 1998 ADA criteria.ConclusionNeither the TTT as a first-line test nor the ADA guidelines are sufficiently adequate screening methods to detect asymptomatic CHD in Japanese subjects with type 2 diabetes. Conducting routine screening for asymptomatic CHD in Japanese patients with type 2 diabetes may therefore not be very useful.

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