The role of new cardiovascular risk factors in the assessment of silent coronary artery disease in diabetic patients : When attending guidelines may not be enough

Silent coronary artery disease (CAD) is common among diabetic patients. The presence of silent CAD is considered a powerful predictor of future cardiovascular events and early death, particularly in diabetic patients. Early identification of diabetic patients with silent CAD can permit their early treatment and consequent improvement of the cardiovascular prognosis. Recent studies showed new powerful predictors of silent CAD in diabetic patients. These predictors are: lipoprotein(a), homocysteine, insulin-resistance and, above all, erectile dysfunction. The case suggests that these new predictors could be effectively used in clinical practice, in order to early identify diabetic patients with silent CAD.