Coronary artery disease screening shows no benefit for individuals with diabetes
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Key takeaways:
- CT screening for coronary artery disease did not impact mortality rate among those with diabetes.
- The rate of revascularization was greater in the treatment group at 4- and 12-year follow-up.
CHICAGO — Coronary CT angiography screening of asymptomatic adults with diabetes for coronary artery disease did not significantly lower mortality or nonfatal myocardial infarction risk, according to longer follow-up of the FACTOR-64 study.
“The major conclusion I have made from the results of this study is that careful adherence to current guidelines-directed cardiovascular prevention medical therapy in patients with diabetes is effective in preventing heart disease in most patients and should be offered to all patients with diabetes irrespective of what might be found if they received a CCTA screening study,” J. Brent Muhlestein, MD, co-director of cardiovascular research at Intermountain Health and professor in the division of cardiology in the department of internal medicine at the University of Utah, told Healio.
Researchers conducted the FACTOR-64 study to determine whether routinely screening patients with type 1 or type 2 diabetes for CAD using coronary CT angiography (CTA), followed by coronary CTA-directed therapy, would lower risk for mortality and nonfatal MI and stroke.
The initial randomized controlled study included 900 patients (median age, 61.5 years; 52% men; 88% type 2 diabetes) with diabetes for at least 3 to 5 years without any symptoms of CAD recruited from July 2007 to May 2013.
The researchers randomly assigned patients to the coronary CTA scanning arm (n = 452) or the national-standard diabetes care arm (n = 448). Based on coronary CTA results, they recommended patients receive standard primary prevention medical therapy or aggressive secondary prevention therapy, which included invasive coronary angiography.
At the initial follow-up of 4 years, the researchers found that the coronary CTA group had a greater rate of revascularization compared with the control group (8.9% vs. 3.1%; P < .005), as well as a trend toward lower incidence of all-cause mortality and nonfatal MI (HR = 0.82; 95% CI, 0.49-1.32).
This follow-up study — presented at the American Heart Association Scientific Sessions — was intended to reveal the effect of coronary CTA screening on these patients after a greater duration of time, with follow-up extended to May 2024. Mean follow-up was 12.7 years for both groups (coronary CTA, 12.8 years; control, 12.6 years).
The trend of higher revascularization in the coronary CTA group continued at long-term follow-up (13.3% vs. 7.8%; P = .008).
However, the researchers found that the composite (HR = 0.92; 95% CI, 0.72-1.18; P = .52) and individual outcomes concerning all-cause mortality (HR = 0.9; 95% CI, 0.69-1.2; P = .5) and MI (HR = 1.04; 95% CI, 0.5-2.16; P = .91) were not significantly different between the groups.
Muhlstein noted that these results were “surprising,” but noted that the recent initiation of an aggressive diabetes medical prevention program by Intermountain Health affected the patients examined in this study. “All patients enrolled in our trial had much better medical management of their blood sugar, cholesterol levels and blood pressure than had historically been accomplished,” he said.
“These findings should discourage the use of [coronary] CTA for screenings in diabetes patients who do not show any symptoms of heart disease,” Muhlestein said in a press release.
Reference:
- Proactively screening people with diabetes for heart disease does not improve long-term mortality or reduce future cardiac events, Intermountain study finds. https://news.intermountainhealth.org/proactively-screening-diabetics-for-heart-disease-does-not-improve-long-term-mortality-or-reduce-future-cardiac-events-intermountain--study-finds/. Published Nov. 19, 2024. Accessed Nov. 25, 2024.
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Muhlestein JB, et al. Abstract MDP1573. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2024; Chicago.
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