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Copyright ©The Author(s) 2015.
World J Diabetes. May 15, 2015; 6(4): 634-641
Published online May 15, 2015. doi: 10.4239/wjd.v6.i4.634
Table 1 Clinical features suggesting diabetes patients at high risk
Diabetes and age > 60 yr
Diabetes and microalbuminuria (> 20 mcg/min or urine albumin to creatinine ratio > 2.5 mg/mmol for males, > 3.5 mg/mmol for females)
Diabetes and moderate or severe chronic kidney disease (persistent proteinuria or eGFR < 45 mL/min per 1.73 m2)
Diabetes and a previous diagnosis of familial hypercholesterolaemia in the individual
Diabetes and systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg
Diabetes and serum total cholesterol > 7.5 mmol/L
Table 2 American Diabetes Association guidelines on stress testing in diabetic patients[23]
Typical or atypical cardiac symptoms
Resting electrocardiogram suggestive of ischaemia or infarction
Peripheral or carotid occlusive arterial disease
Table 3 Signs and symptoms of concern in an otherwise asymptomatic patient
Symptoms suggestive of cardiovascular autonomic neuropathy
Resting tachycardia
Postural hypotension
Signs/symptoms suggestive of coexisting vascular disease Erectile dysfunction Claudication symptoms Carotid bruit Diminished/absent peripheral pulses
Inappropriate exercise tolerance
Shortness of breath without clear pathology
Table 4 Sensitivity and specificity of provocative tests in patients with diabetes
Diagnostic testSensitivity (%)Specificity (%)
Exercise stress test[33]4781
Stress echo[35]8254
Stress nuclear perfusion study[36]8656
CT coronary angiogram[40]7690
Coronary calcium score[39]64-7575-83
Table 5 Sensitivity and specificity of provocative testing in women[44]
Diagnostic testSensitivity (%)Specificity (%)
Exercise electrocardiogram31-7166-78
Exercise echocardiogram80-8879-86
Pharmacological echocardiogram76-9085-94
Nuclear perfusion study78-8864-91
Computed tomography coronary angiogram9779