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SPECT imaging has an 86 sensitivity in patients with greater than 50 stenosis and a 90 sensitivity when the stenosis exceeds 70. 264. Pharmacologic stress imaging using adenosine, dipyridamole (a coronary vasodilator), or dobutamine (which increases myocardial oxygen demand) can substitute for exercise stress testing as a means to detect CHD in patients with diabetes. The ADA recommends screening for cardiac disease in asymptomatic patients when two or more of the following risk factors are present 248 : Total cholesterol 240 mg per dL or higher, LDL-C 160 mg per dL or higher, or HDL-C 35 mg per dL or lower.

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