Abstract:
BACKGROUND:Screening for coronary artery disease (CAD) in asymptomatic diabetic patients with atherogenic risk factors is recommended by the American College of Cardiology/American Diabetes Association. It is not clear whether these guidelines apply to the Japanese population with a different epidemiology of CAD. This study evaluates the applicability of the U.S. guidelines to Japan, taking account of cost-effectiveness. DESIGN:A cost-effectiveness analysis using a Markov model was performed to measure the clinical benefit and cost of CAD screening in asymptomatic patients with diabetes and additional atherogenic risk factors. We evaluated cohorts of patients stratified by age, gender, and atherogenic risks. The incremental cost-effectiveness of not screening, exercise electrocardiography, exercise echocardiography, and exercise single-photon emission-tomography (SPECT) was calculated. The data used were obtained from the literature. Outcomes are expressed as US dollars per quality-adjusted life year (QALY). RESULTS:Compared with not screening, the incremental cost-effectiveness ratio (ICER) of exercise electrocardiography was $31,400/QALY for 60-year-old asymptomatic diabetic men, and 46,600 for 65-year-old women with hypertension and smoking. The ICER of exercise echocardiography was $31,500/QALY and of SPECT was $326,000/QALY, compared with the next dominant strategy. Sensitivity analyses found that these results varied according to age, gender, the combination of additional atherogenic risk factors, and the frequency of screening. CONCLUSION:From a societal perspective the U.S. guidelines on screening for CAD in high risk diabetic patients are applicable to the Japanese population. However, the population subjected to screening should be carefully selected to obtain greatest benefit from screening.
journal_name
Int J Cardioljournal_title
International journal of cardiologyauthors
Hayashino Y,Shimbo T,Tsujii S,Ishii H,Kondo H,Nakamura T,Nagata-Kobayashi S,Fukui Tdoi
10.1016/j.ijcard.2006.03.086subject
Has Abstractpub_date
2007-05-16 00:00:00pages
88-96issue
1eissn
0167-5273issn
1874-1754pii
S0167-5273(06)00756-Xjournal_volume
118pub_type
杂志文章abstract::Cardiovascular morbidity and mortality in patients with type 2 diabetes are a major problem in clinical practice. Thiazolidinediones (TZDs) are agonists of the peroxisome proliferator-activated receptor gamma which improve glycaemic control by reducing insulin resistance. TZDs also seem to have beneficial effects on v...
journal_title:International journal of cardiology
pub_type: 杂志文章,评审
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journal_title:International journal of cardiology
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journal_title:International journal of cardiology
pub_type: 杂志文章
doi:10.1016/s0167-5273(98)00086-2
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journal_title:International journal of cardiology
pub_type: 杂志文章,多中心研究
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abstract::This report describes a 61-year-old female with an anomalous drainage of the right superior vena cava into the left atrium. The patient presented progressively severe dyspnea and precordial pain on exertion, lightheadedness, easy fatiguability and a constant decline in her performance but normal cardiac and pulmonary ...
journal_title:International journal of cardiology
pub_type: 杂志文章,评审
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journal_title:International journal of cardiology
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journal_title:International journal of cardiology
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journal_title:International journal of cardiology
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journal_title:International journal of cardiology
pub_type: 杂志文章
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journal_title:International journal of cardiology
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:International journal of cardiology
pub_type: 杂志文章
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更新日期:2017-08-15 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.ijcard.2009.09.524
更新日期:2011-03-03 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章,评审
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更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:Cardiopulmonary exercise testing (CPET) has become part of screening and evaluation in cardiology. The exercise modalities most often used in CPET are the treadmill (TM) and upright bicycle (UB). Nowadays, also the supine bicycle (SB) is becoming more often used, especially when combined with cardiac imaging...
journal_title:International journal of cardiology
pub_type: 杂志文章,随机对照试验
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更新日期:2016-11-01 00:00:00
abstract::ACEI and AT1 receptor antagonists are the drugs most consistently shown to reduce ADMA level in humans. Unfortunately, most of the human studies addressing the effect of pharmacotherapy on ADMA metabolism were accomplished on small patient subgroups and were relatively shortlasting. Besides, L-arginine was rarely meas...
journal_title:International journal of cardiology
pub_type: 信件
doi:10.1016/j.ijcard.2008.11.109
更新日期:2010-06-25 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.ijcard.2016.09.006
更新日期:2016-12-01 00:00:00
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journal_title:International journal of cardiology
pub_type: 信件
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更新日期:2007-01-31 00:00:00
abstract:BACKGROUND:Hypertension is an important risk factor for cardiovascular diseases. Pathophysiology and molecular mechanisms involved in hypertension regulation are not very well known. Recently, high-throughput Next-Generation Sequencing (NGS) technology has identified hundreds of gene loci associated with multiple cardi...
journal_title:International journal of cardiology
pub_type: 杂志文章,meta分析,评审
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更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Hyperthyroidism is a major cause of paroxysmal atrial fibrillation (AF). The purpose of this study was to evaluate the predictors of AF in the patients with clinical and subclinical hyperthyroidism. METHODS AND RESULTS:The study population consisted of four groups: group I (57 euthyroid healthy persons), gr...
journal_title:International journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.ijcard.2003.11.040
更新日期:2005-03-10 00:00:00
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journal_title:International journal of cardiology
pub_type: 信件
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更新日期:2011-01-21 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2020-05-15 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章
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更新日期:2018-09-01 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章,随机对照试验
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更新日期:2013-09-20 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章
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更新日期:2018-11-01 00:00:00
abstract::Chronic sickle cell (SC) disease is known to cause pulmonary hypertension (PH) which eventually affects right as well as left ventricular function. However, the acute effects of SC crisis on right ventricular (RV) function in adults have not been well described. Our echocardiography database was queried for patients f...
journal_title:International journal of cardiology
pub_type: 信件
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更新日期:2009-03-06 00:00:00
abstract::Coronary artery stenosis is a major complication of Kawasaki disease (KD). Several interventional methods in treating coronary artery stenosis have been introduced. However, there are few reports on the management of in-stent restenosis after coronary stent implantation in children. Reported is a 10-year-old boy who u...
journal_title:International journal of cardiology
pub_type: 信件
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更新日期:2006-11-10 00:00:00
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journal_title:International journal of cardiology
pub_type: 临床试验,杂志文章
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更新日期:2017-04-01 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ijcard.2013.01.224
更新日期:2013-10-03 00:00:00
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journal_title:International journal of cardiology
pub_type: 杂志文章
doi:10.1016/0167-5273(91)90005-a
更新日期:1991-03-01 00:00:00