The association between diabetes mellitus and coronary artery disease (CAD) is wellknown.
Being the leading cause of death in diabetics, CAD is a target for prevention, diagnosis and
treatment. In that sense, silent CAD in diabetics has long been a matter of concern, leading both to
continued attempts at its diagnosis as well as to the persisting challenge of defining if screening for
CAD in the diabetic population is useful and/or warranted.
The most frequent and stronger point in favor of screening rests on the assumption that early diagnosis
of CAD may lead to early treatment and therefore improved outcomes. Nonetheless, screening for
CAD in diabetics is a controversial issue, since studies have not yielded evidence supporting better outcomes in diabetics
screened for CAD compared to nonscreened diabetics. For several reasons, current tests that detect inducible ischemia or
assess atherosclerotic burden may not be able to identify those patients at increased risk. Therefore a cautious look should
be taken (once more) at that question.