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in pilots with diabetes and cause in-flight incapacitation or sudden death. Moreover, the International Air Transport Association found acute coronary syndromes to be the leading cause of sudden incapacitation during either military or civilian flight operations resulting in aircraft accidents and fatalities. 2 Even if silent coronary disease is frequent in patients with diabetes, its detection in primary prevention is still debated. 16 Several noninvasive screening tools have been proposed to detect CAD, and new screening methods with greater performance are