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Camelia Nicolae

Camelia Nicolae

Assistant Professor, Internal Medicine & Cardiology Department, Carol Davila University of Medicine and Pharmacy, Romania

Title: Ischemic stable coronary disease: Between guidelines and “real life”

Biography

Biography: Camelia Nicolae

Abstract

Statement of the problem: The aim of the conference is to emphasize the difference between incidence, prevalence and mortality of stable coronary ischemic disease in “real life” and the data from the guidelines. In the light of current protocols, we diagnose and stratify the risk of stable coronary ischemic disease depending on gender, age and the presence of chest pain. This approach ignores a significant number of asymptomatic subjects who present one or more cardiovascular risk factors. Among this, diabetes mellitus and chronic kidney disease represents clinical equivalents of coronary ischemic disease as the guidelines specifies.
Theoretical orientation: According to a lot of clinical studies performed in UK and USA, the majority percent of sudden death is caused by ischemic heart disease. So, what are the reasons to exclude from diagnose and risk stratification the most vulnerable candidates?  Messrs Bayes de Luna and Roberto Elosua proved in a remarkable study published in 2012, that the greatest numbers of sudden deaths, 300.000/ year are encountered in general population. The second most frequent sudden deaths, 250.000/year, are registered in the subgroup with risk factors in general population. In another study performed in USA and published in 2008, 80% of sudden deaths were caused by coronary ischemic disease. According to the most recent statistic data, the mortality decreases in ischemic heart disease, but its incidence is increasing.
Conclusion: Current guidelines mention that the avoidance of excessive costs for elaborated investigation represented a constant concern, but in “real life” coronary ischemic disease remains under- diagnosed and under- treated. Recommendations: every clinical physician must decide upon the most proper methods to diagnose coronary ischemic disease depending on the clinical data of the patient.

Recent Publications:

  1. Kee-Joon Choi,MD, Jae-Kwan Song, MD, You-Ho Kim, MD, Seong-Wook Park, MD, Seung-Jung Park, MD, Jung-Min Ahn, MD, Ki Hong Lee,MD, Sang-Yong Yoo, MD, Young-Rak Cho, MD, Jon Suh, MD, Eun-Seok Shin,MD, Jae-Hwan Lee, MD, Dong Il Shin, MD, Sung-Hwan Kim, MD, Sang Hong Baek,MD, Ki Bae Seung, MD, Chang WookNam,MD, Eun-SunJin,MD, Se-WhanLee,MD, Jun HyokOh,MD, JaeHyunJang, HyungWookPark,MD, Nam Sik Yoon,MD, Jeong Gwan Cho,MD, Cheol Hyun Lee, MD, Duk-Woo Park, MD, Soo-Jin Kang, MD, Seung-Whan Lee, MD, Jun Kim, MD, Young-Hak Kim, MD, Ki-Byung Nam, MD, CheolWhan Lee, MD, ( 2016), Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death, J Am Coll Cardiol;68:137–45.
  2. Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R, Burns R, Rayner M, Townsend N (2017), European Cardiovascular Disease Statistics, European Heart Network.
  3. Antonio Bayes de Luna, Roberto Elosua, (2012), Sudden Death, Rev Esp Cardiol; 65:1039-1052.
  4. Jaskanwal D. Sara, MBChB; Mackram F. Eleid, MD; Rajiv Gulati, MD, PhD;and David R. Holmes Jr, MD, (2014), Sudden Cardiac Death From the Perspective ofCoronary Artery Disease,Mayo Clin Proc, 89(12):1685-1698.
  5. Sumeet S. Chugh, Kyndaron Reinier, Jonathan Jui, (2008), Epidemiology of sudden cardiac death: clinical and research implication, Prog Cardiovasc Dis, 51(3): 213-228.