Diabetics are at a higher risk for heart disease than the general population. In fact, heart disease is the most common cause of death in people who have diabetes. This raises an important question. If you’re diabetic, should you get exercise stress testing to screen for heart disease – even if you don’t have symptoms?
Should People Who Have Diabetes Get Exercise Stress Testing?
Unfortunately, there’s no clear-cut answer to this question and even doctors can’t even agree on the issue. Most doctors get a routine screening ECG (heart tracing) on people who have diabetes every few years, but a resting ECG is not a good tool for picking up silent heart disease in diabetics or anyone else. It’s really only a good diagnostic test when a person is having chest pain or a heart attack, an abnormal heart rhythm, or for looking to see whether a person has had a heart attack in the past.
Standard exercise stress testing isn’t the even the best test for diagnosing silent heart in people who have diabetes. The chance of picking up silent heart disease with standard stress testing depends on how severe the heart disease is. In people who have disease involving only one blood vessel, exercise stress testing can be falsely negative up to half the time. Even in cases of more advanced heart disease, stress testing will be negative around fifteen percent of the time. Not very reassuring, is it?
Standard Exercise Stress Testing vs. Nuclear Stress Testing
Nuclear stress testing, where you’re injected with a radioactive dye prior to exercise testing. This is much sensitive than standard exercise stress testing, but it’s also more expensive and involves exposure to radiation. There’s also a small risk of developing an allergic reaction to the dye used in the procedure.
So, should you get an exercise stress test if you have diabetes but no symptoms of heart disease? People who have diabetes are more likely to have silent heart disease. Which means they have no symptoms despite having significant blockage of the coronary arteries. Diabetics are less likely to experience chest pain and other symptoms of heart disease than normal people, partially due to diabetic-related nerve damage. This means heart disease can go undiagnosed – with disastrous results.
Exercise Stress Testing for People Who Have Diabetes: The Bottom Line?
If you have diabetes and any other risk factors for heart disease such as a strong family history, high lipid levels, high blood pressure, a history of smoking, or obesity, it’s a good idea to get an exercise stress test by age fifty as a screening test for silent heart disease.
If you’re at very high risk for heart disease or if you’re female, it’s better to get nuclear stress testing. Nuclear stress testing is more sensitive than standard exercise stress testing. Women are more likely to have a false negative standard exercise stress test than men, so they need a more sensitive test. If it’s normal, you probably won’t need another stress test for ten years as long as you don’t develop new symptoms of heart disease.
If you’re diabetic, talk to your doctor about your risk factors for heart disease and whether or not stress testing is right for you.
Journal of Family Practice. Vol. 59, No. 5. May 2010. pages 262-268.