Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Can J Diabetes. 2020 Feb;44(1):86-92. doi: 10.1016/j.jcjd.2019.08.009. Epub 2019 Aug 23.
If a disease state is highly prevalent and its consequences are severe, it may be appropriate to seek methods to identify it early to forestall its development and complications. Diabetes mellitus is a proven risk factor for the development of atherosclerosis, although its face and outcome are changing, as shown in contemporary clinical trials. In fact, decompensated heart failure seems to drive the hospitalization rate in patients with diabetes, and mortality from heart failure is reduced with modern hypoglycemic treatments. Nonetheless, atherosclerotic complications continue to be a major health concern in this segment of the population and cardiovascular imaging has been employed in an attempt to achieve a more accurate risk stratification. Although imaging for detection of obstructive coronary artery disease failed to reach such a goal, imaging for preclinical atherosclerosis may be more successful. In this review, we discuss the use of computed tomography and positron emission tomography to detect preclinical coronary atherosclerosis in asymptomatic patients with diabetes. Despite recent advances in the field, several questions remain to be answered as to the ultimate benefit of imaging for prevention in diabetes mellitus.
如果一种疾病的发病率很高，其后果很严重，那么寻找早期发现它的方法来阻止其发展和并发症可能是合适的。糖尿病是动脉粥样硬化发展的已知危险因素，尽管其表现和结果正在发生变化，如当代临床试验所示。事实上，失代偿性心力衰竭似乎驱动了糖尿病患者的住院率，而现代降糖治疗降低了心力衰竭的死亡率。尽管如此，动脉粥样硬化性并发症仍然是这部分人群的主要健康关注点，心血管成像已被用于试图实现更准确的风险分层。尽管用于检测阻塞性冠状动脉疾病的成像未能达到这一目标，但用于检测临床前动脉粥样硬化的成像可能更为成功。在这篇综述中，我们讨论了使用计算机断层扫描和正电子发射断层扫描来检测无症状糖尿病患者的临床前冠状动脉粥样硬化。尽管该领域最近取得了进展，但对于糖尿病预防成像的最终益处，仍有几个问题需要回答。
