Proactively screening diabetes patients for heart disease does not improve long-term survival

While coronary heart disease and diabetes are often seen in the same patients, a diagnosis of diabetes does not necessarily mean that patients also have coronary heart disease, according to a new study from researchers at Intermountain Health in Salt Lake City.

The Intermountain study found that proactively screening patients with diabetes 1 and 2 for coronary heart disease who have not shown symptoms of heart problems does not improve long-term mortality rates, nor does it lower the chance of them having a heart attack or stroke in the future.

Our study found that doing these kinds of screenings on patients doesn't make any marked difference in their long-term survival rates."

J. Brent Muhlestein, principal investigator of the study and co-director of cardiovascular research at Intermountain Health

"Instead, results of our study reinforce that we should be focusing on other proven interventions for people with diabetes, like medication management, diet and exercise, to help these patients lead long and healthy lives," he added.

Findings from the Intermountain Health study were presented at the American Heart Association's Scientific Sessions 2024 in Chicago on Monday, November 18.

For the study, Intermountain Health researchers examined data from FACTOR-64 study, a randomized clinical trial of 900 people with type 1 or type 2 diabetes for at least three to five years without coronary artery disease symptoms.

Of these patients, 452 were screened with a coronary computed tomography angiography (CCTA), which uses a powerful X-ray to make a 3D image of the heart. Researchers compared these patients with a control group of 448 people who were treated with standard optimal diabetes care guidelines.

Enrollment occurred between July 2007 and May 2013, and followed up on in May 2024.

Researchers found that using CCTA to screen for cardiovascular disease did not significantly affect the rates of all-cause mortality or of non-fatal heart incidents, like heart attack and stroke. This was true when researchers initially followed up four or five years after the CCTA screening, and again at 12 years.

"These findings should discourage the use of CCTA for screenings in diabetes patients who do not show any symptoms of heart disease," said Dr. Muhlestein.

"While our study showed that screening for coronary heart disease with CCTA won't make any difference, it did show that if patients carefully medically manage their diabetes, they may live almost as long as somebody who does not have diabetes, which wasn't the case before," said Dr. Muhlestein. "This study shows that, even over an extended period of time, a screening like this can't replace those kinds of critical behaviors."