What happens if you do too much exercise?

28th July 2025, A/Prof Chee L Khoo

We have explored the association between intensive endurance athletes and cardiovascular events in the past. Data on the dose–response relationship between long-term intensive endurance exercise and coronary heart disease has been rather conflicting over the years. While early studies suggest that regular endurance athletes have lower ischaemic heart disease (1), later studies reported an increased prevalence of coronary atherosclerotic plaques amongst highly trained athletes in comparison to healthy non-athletes (2–4).…

HFpEF – what else can we use in addition to an SGLT2 inhibitor?

28th July 2025, A/Prof Chee L Khoo

We are all aware of the four pillars of treatment in the guideline directed medical treatment (GDMT) of patients with heart failure with reduced ejection fraction (HFrEF) – SGLT2 inhibitors (SGLT2i), angiotensin receptor neprilysin inhibitor (ARNI), beta blockers and mineralocorticoid receptor antagonist (MRA). When we come to heart failure with preserved ejection fraction (HRpEF), the pillar of treatment is rather lonely – SGLT2i only.…

NIA Diagnostic Imaging is now in Cabramatta

14th July 2025, NIA Diagnostic Imaging

We’re thrilled to announce the upcoming opening of NIA Diagnostic Imaging in Cabramatta — bringing state-of-the-art medical imaging services right to your doorstep.

As Cabramatta’s first MRI facility, we’re excited to offer the latest in diagnostic technology for our community. Whether you’re looking for diagnostic imaging of the brain, spine, joints, or soft tissues, our high-quality MRI scans provide detailed and accurate results to guide your treatment.…

What happens if you become frail?

14th July 2025, A/Prof Chee L Khoo

Frail?

It’s amazing how we have learnt to accept declining muscle function and increasing frailty as part of our patients getting older. At GPVoice, we have explored muscle health and sarcopenia many times over the couple of years. We know that declining muscle health is associated not only with falls risk but also with increase mortality rates in COPD, heart disease, osteoporosis and post surgical outcomes.…

Who should not go vegan?

30th June 2025, A/Prof Chee L Khoo

There are many reasons why some of our patients go vegetarian. A primarily plant-based diet with less meat is supposed to lower the morbidity of chronic diseases, including cardiovascular diseases, type 2 diabetes, and certain cancers [1]. Some patients may choose to reduce their food-related ecological footprint. A transition to a diet that contains more plant-based products and less meat could increase food availability while releasing the burden on the environment [2].…

Papillary thyroid cancer – diagnosis and treatment

12th June 2025, NIA Diagnostic Imaging

Papillary thyroid carcinoma (PTC) is the most prevalent type of thyroid malignancy, accounting for approximately 75–90% of all thyroid cancer cases (Cozens, 2011; Solbiati et al., 2017). These tumours are typically slow-growing and display distinctive histologic features, including papillary structures, nuclear alterations, and multiple subtypes (Gonzalez-Gonzalez et al., 2011; Limaiem et al., 2023). The prognosis is generally favourable, with survival rates exceeding 90% and low mortality rates, ranging from 4–8% (Cozens, 2011; Solbiati et al., 2017).…

Atrial fibrillation – paradigm changes in management

11th June 2025, A/Prof Chee L Khoo

AF?

Atrial fibrillation (AF) is associated with 1.5 – 2-X risk of death (1,2), 2.4-X risk of stroke (2), 5-X risk of heart failure (HF) (2), 1.5-X risk of myocardial infarction (MI) (3), 2-X risk of sudden cardiac death (4), 1.6-X risk of chronic kidney disease (CKD) (2), 1.5-X risk of cognitive impairment or dementia (5) and 1.3-X risk of peripheral artery disease (PAD) (2).…

Hypertriglyceridaemia – limited options but …

27th May 2025, A/Prof Chee L Khoo

ASCVD

Hypertriglyceridaemia (HTG) causes and contribute to a number of serious medical conditions including pancreatitis, cardiovascular disease, MAFLD and worsening of type 2 diabetes. The efficacy and treatment options are complicated. Apart from treating any secondary causes, our treatment options are quite limited. Marine-derive omega-3 fish oils, fenofibrate and the new icosapent ethyl are all we have in our tool kit.…

New Acute Coronary Syndrome guidelines – is it relevant to GPs?

24th May 2025, A/Prof Chee L Khoo

Acute coronary syndrome (ACS)

One of the problems keeping up to date in primary care is not being aware of new guidelines that has been released. Well, the joint National Heart Foundation and Cardiac Society of ANZ released the new Australian clinical guideline for diagnosing and managing acute coronary syndromes (ACS) just a month ago (1).…

Understanding coronary artery calcium (CAC) scoring

14th May 2025, NIA Diagnostic Imaging

ASCVD

Coronary artery calcium (CAC) scoring is a well-established, non-invasive imaging technique for assessing cardiovascular risk by identifying and quantifying calcified plaque in the coronary arteries. The CAC score, a direct marker of subclinical atherosclerosis, highly predicts future cardiovascular events, making it an essential tool for clinicians in assessing risk, even in asymptomatic individuals. (4, 5)

CAC scoring facilitates early identification of at-risk individuals by providing an objective assessment of coronary artery disease (CAD) burden, allowing for more targeted and proactive cardiovascular health care.…

Carotid endarterectomy – are treatment guidelines review overdue?

13th May 2025, A/Prof Chee L Khoo

Stroke prevention

Patients with carotid stenosis either go for intensive medical treatment or carotid endarterectomy. Trials conducted in the 1980s and 1990s have shown that carotid endarterectomy (CEA) can reduced the risk of stroke in patients with symptomatic carotid stenosis of ≥ 50% and to a smaller extent in patients with asymptomatic stenosis, compared with best medical treatment.…