Have you check your lipoprotein (a) yet?

31st October 2025, A/Prof Chee L Khoo

We have covered the issue of lipoprotein (a) on a number of occasions in the past. We highlighted how the additional atherosclerotic harm in patients with elevated levels. Although lipoprotein (a) lowering agents are yet to hit the market, it is still important to check the levels at least once in all patients as the results may influence your LDL-C targets as well as prompt further cardiovascular investigations.…

Aspirin for primary CV prevention – more data out

31st October 2025, A/Prof Chee L Khoo

aspirin for primary prevention

The role of aspirin is well established in secondary prevention of cardiovascular events. However, it’s coming up to 10 years since international guidelines specifically recommend against aspirin in primary prevention of CV events (1-3). There have been a number of landmark studies looking at the risk and benefits of aspirin in primary prevention.…

The many clinical trials of semaglutide

11th October 2025, A/Prof Chee L Khoo

Injectable semaglutide

Weekly semaglutide injectable has been around for some years now. Even with my special interest in diabetes and obesity, I am getting confused with all the clinical trials involving semaglutide in patients with obesity with or without diabetes. They all have very innovative acronyms most of them starting with “S” which makes them hard to keep track of.…

Should we screen for helicobacter infection in patients on aspirin?

29th September 2025, A/Prof Chee L Khoo

aspirin related GI bleeding

I must admit that I have been doing this for many years on an ad hoc basis. I have been screening for helicobacter pylori (HP) infection in patients who need to be on aspirin (primary or secondary prevention of coronary artery disease). This isn’t what is recommended in any cardiovascular (CV) disease guidelines until recently but the evidence is not robust.…

Digoxin making a comeback?

29th September 2025, A/Prof Chee L Khoo

heart failure

Digitalis is one of the oldest drugs in cardiovascular (CV) medicine and has generally been used in patients with heart failure (HF) and in those with atrial fibrillation (AF) or in both (1,2).  In fact, up until 25 years ago, digitalis in the form of digoxin was used in around two thirds of patients with moderate to severe heart failure.…

Adding aspirin to anti-coagulants – how safe is it?

6th September 2025, A/Prof Chee L Khoo

We all have patients at risk of thromboembolism (mainly from atrial fibrillation risks) and atherosclerotic cardiovascular disease (primarily, coronary artery disease). They may require both anti-coagulant as well as anti-platelet therapy. Sometimes, we don’t have a choice as they have high risks for both. Theoretically, they at high bleeding risks. Yet, our cardiology colleagues have to make that difficult decision to continue both.…

Oral GLP1-RAs coming soon? – they are already here

13th August 2025, A/Prof Chee L Khoo

Oral GLP1-RA

We know the ongoing cost and availability of anti-obesity medications (AOM) the likes of Wegovy and Mounjaro although we have been assured that the supply issue is behind us now. Part of the problem with cost relate to the manufacturing cost of the devices. In fact, the rate limiting step to the production is the pen, which needs to be precisely manufactured and tested as it is a medical device.…

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.…

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).…