OBJECTIVE: To determine the rate of CVD in asymptomatic individuals with diabetes mellitus [DM] using non-invasive myocardial perfusion imaging [MPI]. METHODS: This observational study identified individuals with DM [ICD-9-CM 250.0] from an administrative database maintained by VISN 22 [Department of Veterans' Affairs]; and, patients received all in-patient and out-patient care from this VISN. One cohort of 53-year old males consisted of individuals who did not undergo MPI over a 24-month interval [n=60]; another cohort included attribute-matched individuals who had undergone MPI during the same interval. This group did not undergo MPI due to ischemia or other clinical findings of CAD. Evidence of MPI utilization consisted of HCPCS code assignment. Patient records were examined to identify post-MPI CVD and interval morbidity. RESULTS: Of those who did not undergo MPI, 15% experienced CVD-related events during the observation interval including acute MI [n=7], dysrhythmias, and heart failure; however, 25% of MPI studies were abnormal in the second cohort, no patients experienced acute MI, and dysrhythmias and heart failure occurred in two patients [p<0.01]. The rate of CVD events in the first cohort is 0.375/month whereas in the second cohort it is 0.083/month [p<0.001]. Half of the abnormal MPI studies identified multi-vessel CAD. Eleven patients underwent CABG procedures in the second cohort based on findings at MPI; none of the non-MPI patients underwent such intervention. CONCLUSIONS: MPI detected CVD in asymptomatic patients with DM which resulted in appropriate intervention and improvement in net health outcomes. Up to 22% of individuals in the US with DM have asymptomatic CVD, and appropriate use of MPI should be considered in this setting.