Cardiovascular disease (CAD) screening in asymptomatic patients with diabetes mellitus is controversial. An exercise stress test is a safe and effective initial testing for Ischemic Heart Disease (IHD) screening. Treadmill stress test is not the best screening method for a particular patient who is not able to exercise, abnormal electrocardiogram (ECG) or positive exercise treadmill test (ETT) and other anatomical or functional studies are recommended to evaluate for the myocardial ischemia. This concept is supported by the high rate prevalence of silent myocardial ischemia, CAD and cardiovascular events rate. Coronary angiography is an expensive and invasive test which is considered as gold standard for diagnosis obstructive CAD and not be used for screening. In this review article we discussed about anatomical modalities (Coronary Artery Calcium Score (CACS)) and nuclear imaging (SPECT) for evaluation of silent ischemia.