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Improving risk stratification for coronary artery disease (CAD) is one of the fundamental questions clinicians face routinely.There are enormous financial implications of screening asymptomatic subjects even traditionally considered high risk such as diabetics.In individual patients, non-invasive determination of presence of CAD is made from an estimation of the clinical pretest probability for CAD and the results of stress testing.However screening of asymptomatic subjects with diabetes for coronary artery disease remains a controversial topics.Diabetic subjects with negative stress tests have much higher cardiac ischemic events than non diabetics.However the role of screening remains yet to be adequately defined.The recent prospective DIAD trial showed how many subjects with CAD would have been missed had recommended guidelines been used for screening them.The follow up part of the study showed that routine screening may not benefit subjects in terms of reduction of cardiac ischemic events.Thus the benefits of screening still remain to be clearly defined.The purpose of this talk is to update the clinicians with the latest knowledge about risk assessment and prognosis is diabetes and coronary artery disease.