{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T14:49:46Z","timestamp":1792162186602,"version":"4.4.0"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Diabetes mellitus markedly increases atherosclerotic cardiovascular risk, and coronary artery disease remains a leading cause of morbidity and mortality. Silent myocardial ischemia (SMI) is clinically relevant in diabetes because autonomic dysfunction and altered pain perception may attenuate typical ischemic symptoms; however, the clinical benefit of routine screening in asymptomatic individuals without known coronary artery disease (CAD) remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether systematic screening for silent myocardial ischemia or occult CAD in asymptomatic adults with diabetes and no known CAD improves major cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review of studies published from January 1, 2000 through March 31, 2025. The primary effectiveness synthesis included randomized trials comparing systematic screening with no systematic screening or usual care. Primary outcomes were major adverse cardiovascular events (MACE), cardiovascular mortality, and all\u2010cause mortality; secondary outcomes included detection yield, downstream testing or revascularization, and reported screening\u2010related harms. Compatible study\u2010level hazard ratios (HRs) and risk ratios (RRs) were synthesized on the log scale using random\u2010effects inverse\u2010variance meta\u2010analysis, with heterogeneity and sensitivity analyses prespecified. The review was not prospectively registered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five RCTs (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093315; DIAD, DYNAMIT, FACTOR\u201064, DADDY\u2010D, and the pilot trial by Faglia et al.) met the eligibility criteria. Screening did not significantly reduce major cardiovascular outcomes in the four trials included in the quantitative synthesis (pooled HR\/RR 0.76; 95% CI 0.48\u20131.19). DYNAMIT was synthesized narratively because its published primary composite was not directly harmonizable with the pooled endpoint. Reporting of false\u2010positive results and procedure\u2010related harms was incomplete and heterogeneous.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In asymptomatic adults with diabetes and no known CAD, routine screening detects occult ischemia or atherosclerosis but has not demonstrated a reduction in MACE or mortality compared with the trial\u2010era usual\u2010care or protocol\u2010defined medical\u2010management strategies studied. These findings do not support routine population\u2010wide screening; selective testing is most defensible when the result is expected to change management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70470","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T09:37:42Z","timestamp":1791193062000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Screening Strategies for Silent Myocardial Ischemia in Individuals With Diabetes Without Known Coronary Artery Disease: Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4764-6429","authenticated-orcid":false,"given":"Vanessa del Carmen","family":"Romero Mart\u00ednez","sequence":"first","affiliation":[{"name":"Universidad Sim\u00f3n Bol\u00edvar Barranquilla Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0467-8107","authenticated-orcid":false,"given":"Juan Pablo","family":"Tob\u00f3n Cuenca","sequence":"additional","affiliation":[{"name":"Pontificia Universidad Javeriana Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7545-5322","authenticated-orcid":false,"given":"Paula Alejandra","family":"Longas Garc\u00eda","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Universitaria Juan N. Corpas Universidad del Tolima Ibagu\u00e9 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5220-0616","authenticated-orcid":false,"given":"Luis Eduardo","family":"Salazar Moreno","sequence":"additional","affiliation":[{"name":"Universidad de Ciencias Aplicadas y Ambientales (UDCA) Universidad de Ciencias Aplicadas y Ambientales (UDCA) Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3759-5448","authenticated-orcid":false,"given":"Gloria Ibis","family":"Tirado Romero","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Universitaria de Ciencias de la Salud (FUCS) Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"S207","volume-title":"Diabetes Care","author":"American Diabetes Association Professional Practice Committee","year":"2024"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.27.8.1954"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz486"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.476"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-12-23"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.15825"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2015.05.006"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-1607"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2017.4191"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2014.07.010"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaf126"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.6897"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_10_15_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. 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