Resolution of Asymptomatic Myocardial Ischemia in Patients With Type 2 Diabetes in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Study

  1. Frans J. Th. Wackers, MD1,
  2. Deborah A. Chyun, PHD2,
  3. Lawrence H. Young, MD1,
  4. Gary V. Heller, MD3,
  5. Ami E. Iskandrian, MD4,
  6. Janice A. Davey, MSN1,
  7. Eugene J. Barrett, MD5,
  8. Raymond Taillefer, MD6,
  9. Steven D. Wittlin, MD7,
  10. Neil Filipchuk, MD8,
  11. Robert E. Ratner, MD9,
  12. Silvio E. Inzucchi, MD1 and
  13. for the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Investigators *
  1. 1Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
  2. 2Yale University School of Nursing, New Haven, Connecticut
  3. 3Hartford Hospital, Hartford, Connecticut
  4. 4University of Alabama, Birmingham, Alabama
  5. 5University of Virginia, Charlottesville, Virginia
  6. 6University of Montreal, Montreal, Quebec, Canada
  7. 7University of Rochester, Rochester, New York
  8. 8Cardiology Consultants, Calgary, Alberta, Canada
  9. 9Medstar Research Institute, Washington, DC
  1. Address correspondence and reprint requests to Frans J.Th. Wackers, MD, Yale University School of Medicine, Section of Cardiovascular Medicine, 333 Cedar St. Fitkin-3, New Haven, CT 06520. E-mail: frans.wackers{at}


OBJECTIVE—The purpose of this study was to assess whether the prevalence of inducible myocardial ischemia increases over time in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS—Participants enrolled in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study underwent repeat adenosine-stress myocardial perfusion imaging 3 years after initial evaluation. Patients with intervening cardiac events or revascularization and those who were unable or unwilling to repeat stress imaging were excluded.

RESULTS—Of the initial 522 DIAD patients, 358 had repeat stress imaging (DIAD-2), of whom 71 (20%) had ischemia at enrollment (DIAD-1). Of 287 patients with normal DIAD-1 studies, 259 (90%) remained normal in DIAD-2, whereas 28 (10%) developed new ischemia in DIAD-2. Of the 71 patients with abnormal DIAD-1 studies, 56 (79%) demonstrated resolution of ischemia, whereas 15 (21%) remained abnormal. During this 3-year interval, medical treatment was intensified, with more patients using statins, aspirin, and ACE inhibitors than at baseline. Patients with resolution of ischemia had significantly greater increases in these medications than patients who developed new ischemia (P = 0.04).

CONCLUSIONS—Thus, the majority of asymptomatic patients with type 2 diabetes demonstrated resolution of ischemia upon repeat stress imaging after 3 years. This resolution was associated with more intensive treatment of cardiovascular risk factors.


  • Published ahead of print at on 6 August 2007. DOI: 10.2337/dc07-1250.

  • F.J.Th.W. has received research grants from Bristol Myers-Squibb Medical Imaging, Astellas Pharma US, General Electric Healthcare, and Bracco Diagnostics; has received honoraria for serving as a speaker from Bristol Myers-Squibb Medical Imaging, Astellas Pharma US, King Pharmaceuticals, and General Electric Healthcare; and serves on the scientific advisory board of King Pharmaceuticals.

  • *

    * A complete listing of the DIAD Study Investigators is listed in the appendix.

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted July 27, 2007.
    • Received July 1, 2007.
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  1. Diabetes Care vol. 30 no. 11 2892-2898
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