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|Year : 2014 | Volume
| Issue : 4 | Page : 418
Duke's treadmill score in diabetics-does it really matter?
Department of Cardiology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||5-Nov-2014|
Dr. R V Lohiya
Department of Cardiology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Lohiya R V. Duke's treadmill score in diabetics-does it really matter?. J Postgrad Med 2014;60:418
This letter pertains to original article by Erkan, et al. published in the recent issue. In this study authors attempted to correlate Duke's treadmill score (DTS) with demographic and biochemical characteristics of enrolled subjects and statistically proved a positive correlation between DTS and serum HDL cholesterol levels. The patient population was classified in two groups as low and moderate to high risk according to Duke's treadmill scores and both groups had no statistically significant difference in distribution of coronary artery disease (CAD) risk factors. I would like to draw your attention to distribution of diabetics in two groups with number far more, i.e. 19% in the low risk group versus 10.5% in the moderate to high risk group. This discrepancy in distribution of diabetics may not be merely by chance. It could well be that diabetics have lower DTS compared to non-diabetics for given CAD burden.  Long-term complications of diabetes in the form of diabetic neuropathy and nephropathy, physical deconditioning and obesity leads to inability to achieve maximum workload to induce ischemia and its related symptoms and ECG changes. Another potential reason may be that diabetic neuropathy causes decreased perception of angina, which is one of the variables in DTS.
Lakkireddy, et al. in their study also observed that diabetics with moderate DTS had higher major cardiac event rates compared to non-diabetics. Thus, although DTS is a good score for post test cardiac risk stratification, with erroneous low scores, diabetic individuals may fall into the intermediate or low risk group and maybe wrongly managed conservatively. 
| :: References|| |
Erkan AF, Ekici B, Demir GG, Töre HF. Lower levels of serum high-density lipoprotein cholesterol are associated with a worse Duke treadmill score in men but not in women. J Postgrad Med 2014;60:260-4.
Shaw LJ, Peterson ED, Shaw LK, Kesler KL, DeLong ER, Harrell FE Jr, et al.
Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups. Circulation 1998;98:1622-30.
Lakkireddy DR, Bhakkad J, Korlakunta HL, Ryschon K, Shen X, Mooss AN, et al.
Prognostic value of the Duke Treadmill Score in diabetic patients. Am Heart J 2005;150:516-21.
George DH, Russell DW. Exercise stress testing in patients with type 2 diabetes: When are asymptomatic patients screened? Clin Diabetes 2007;25:126-30.