The recent Scientific Statement from the American Heart Association (AHA) and the American Diabetes Association (ADA) on cardiovascular disease in T1DM discourages routine CAD screening beyond resting ECG. However, performing a screening test for SMI in the whole T1DM population is unfeasible (both from a clinical and economic point of view), making such identification a real challenge. Therefore, early identification of SMI in subjects with T1DM is essential. Its presence is associated with a worse prognosis and it predicts major cardiovascular events. The prevalence of SMI in subjects with T1DM is in the range 15–43%, while it affects 1–4% of non-diabetic subjects. SMI is defined as the presence of myocardial ischemia without symptoms and it is usually present long before the first CAD event occurs. This delayed diagnosis is partially explained by a higher prevalence of silent myocardial ischemia (SMI), being silent approximately half of all the myocardial infarctions. In T1DM, CAD is usually diagnosed in advanced stages and is associated with a worse prognosis compared with the non-diabetic population. Additionally, CAD produces important disabilities (e.g., heart failure, angina), which cause quality of life to deteriorate and involve considerable economic costs. It causes a life-expectancy loss of about four years, which represents one-third of these subjects’ total life-expectancy loss. The relative risk of death by CAD in T1DM can be as much as ten times greater than in the non-diabetic population, especially in women, and it is even greater than the relative risk in type 2 diabetes (T2DM). Coronary artery disease (CAD) is its principal clinical manifestation. Llauradó was supported by a “Rio Hortega” research fellowship (CM12/00044) from the Instituto de Salud Carlos III (Spain).Ĭompeting interests: The authors have declared that no competing interests exist.Ĭardiovascular disease (CVD) is the main cause of death in patients with type 1 diabetes mellitus (T1DM), representing around 40–47% of deaths in certain cohorts. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: All relevant data are within the paper and its Supporting Information files.įunding: Financial support was provided through a grant from the Associació Catalana de Diabetis (Beca Gonçal Lloveras 2012) and the Fondo de Investigación Sanitaria (FIS) PI12/00954 as part of the National R+D+I (2008–2011) and was cofinanced by the Instituto de Salud Carlos III - General Evaluation Branch (Spanish Ministry of Economy and Competitiveness) and the European Regional Development Fund (ERDF). Received: OctoAccepted: MaPublished: April 3, 2017Ĭopyright: © 2017 Llauradó et al. PLoS ONE 12(4):Įditor: Doan TM Ngo, University of Adelaide, AUSTRALIA The potential role of insulin resistance. (2017) Type 1 diabetes: Developing the first risk-estimation model for predicting silent myocardial ischemia. Citation: Llauradó G, Cano A, Hernández C, González-Sastre M, Rodríguez A-A, Puntí J, et al.
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