It is not yet the time to stop screening diabetic patients for silent myocardial ischaemia

Despite the intensified control of risk factors, silent myocardial ischaemia (SMI) is still a frequent complication of diabetes that is also associated with a higher risk of cardiac events. The objectives of this review are to summarize the importance of screening for SMI in a subset of asymptomatic diabetic patients. There is evidence that screening markedly improves the evaluation of cardiovascular risk compared with the usual risk scores. New markers, validated by large-scale studies, are needed to help in identifying the patients with silent coronary stenoses, thereby lowering the number of screened patients. Some indications of benefit with revascularization in patients with silent coronary stenoses are also available. Although it is not yet time to stop screening diabetic patients for SMI, such screening should focus on patients who are at high or intermediate cardiovascular risk. Guidelines need to be updated to increase the value of screening.