Icosapent ethyl for hypertriglyceridaemia – who is eligible?

12th December 2024, A/Prof Chee L Khoo

ASCVD

Back in August this year, when we last highlighted the benefits of the new pure eicosapentaenoic acid (EPA), icosapent ethyl (Vazkepa®), in reducing cardiovascular outcomes in patients with high triglycerides and high cardiovascular risk, we foreshadowed that it will be available on the PBS for patients with established cardiovascular disease. It is now on PBS Authority and there isn’t much of a launch of the drug which is a pity as many of our patients who may benefit from icosapent ethyl who should be on it aren’t because most of us (including me) are still confused as to who will benefit and who is eligible.…

Tirzepatide – another kid on the block for HFpEF

18th November 2024, A/Prof Chee L Khoo

HFpEF

Amongst the many causes of heart failure with preserved ejection fraction (HFpEF) is obesity. This is not surprising because obesity is now considered an inflammatory chronic disease. Increase adiposity leads to increased released of pro-inflammatory cytokines which damages myocardial muscles. It would then follow that reducing that fat mass would reduce the pro-inflammatory environment and result in lower incidence of HFpEF as well as reducing complications of HF.…

BNP for heart failure now Medicare funded – who needs them?

27th October 2024, A/Prof Chee L Khoo

Patients with heart failure have high mortality and morbidity. Each time they are admitted into hospital with an exacerbation, their cardiac function deteriorate and usually do not return to pre hospital level when they are better. Many of these patients have other co-morbidities which can mask their symptoms or they are in and out of hospital with the other co-morbidities that the HF is overlooked.…

HFpEF management – a second kid on the block has emerged

12th September 2024, A/Prof Chee L Khoo

finerenone

We explored the four pillars of treatment for patients with heart failure with reduced ejection fraction (HFrEF) a few years ago now. In patients with heart failure with preserved ejection fraction (HFpEF) however, the options are quite limited. SGLT2 inhibitors is the only class of agents that has been shown to reduce major adverse cardiovascular events (MACE).…

Hypertriglyceridaemia – is it really bad?

11th August 2024, A/Prof Chee L Khoo

Hypertriglyceridaemia

Treating the CV risk factors like hypertension, diabetes mellitus, hypercholesterolemia and smoking have led to significant reductions in cardiovascular disease and mortality. However, up to 25% of first-time patients with myocardial infarction are SMuRF-less. We explored the issue last fortnight. Essentially, SMuRF-less patients are patients who do not have the usual standard modifiable risk factors (SMuRF).…

Does low salt really reduce BP and CVD?

More salt?

High salt intake is said to independently contribute to high blood pressure and ultimately, increase cardiovascular disease (CVD). There are also many other diseases that are similarly associated with high salt intake. How robust is the evidence though? As we ponder about the associations, we may or may not push the message of salt reduction as strongly as we should.…

Does salt reduction really reduce BP and CVD?

21st July 2024, A/Prof Chee L Khoo

Salt intake

I know this what we were all led to believe – high salt intake independently contributes to high blood pressure and ultimately, increases cardiovascular disease (CVD). Further, reducing salt intake will reduce blood pressure and thence, cardiovascular disease. We may sometimes wonder how strong the evidence for both statements is. As we ponder about the associations, we may or may not push the message of salt reduction as strongly as we should.…

Intravenous iron for iron deficiency – can you give too much?

13th July 2024, A/Prof Chee L Khoo

Iron infusion

Iron deficiency can occur in a number of scenarios. It can arise from blood loss (gastrointestinal, gynaecological), inadequate dietary sources or limited absorption in inflammatory conditions (e.g CKD, heart failure or diabetes). Oral iron supplements not only can have annoying GI side effects but absorption is poor under the best of conditions.…

SMuRF-less myocardial infarctions – what are they?

12th July 2024, A/Prof Chee L Khoo

Myocardial Infarction

We are always on the look out for the traditional cardiovascular risk factors – hypertension, diabetes, lipids and smoking to reduce the risk of adverse cardiovascular events. These are termed standard modifiable cardiovascular risk factors (SMuRFs). Unfortunately, there are a significant number of patients that present with acute coronary syndrome (ACS) who has none of the SMuRFs.…

The deadly exacerbations of COPD

30th June 2024, A/Prof Chee L Khoo

CVD in COPD

We are all aware of the exacerbations in patients with chronic obstructive pulmonary disease (COPD) especially when they are discharged from hospital back to primary care. We tend to forget that each time a patient with COPD have flare up or chest infection, that represent an exacerbation of COPD. Now, you may think it’s just a matter of semantics and coding but it’s more than that.…

Childhood dyslipidaemia – what happens to these kids?

30th June 2024, A/Prof Chee L Khoo

childhood dyslipidaemia

We advocate applying protective sunscreens for little babies onwards because most of the sun damage starts from young and often, we fight a losing battle trying to rescue severe sun damaged skin in later life. It wouldn’t be any different in dyslipidaemia in children and adults. When you think about it, it really doesn’t matter what age you are.…

Coronary CT Angiogram – should we be ordering more?

10th June 2024, A/Prof Chee L Khoo

coronary CT angiogram

Identification of individuals at high risk of atherosclerotic cardiovascular events is actually quite challenging in practice. There are many predictive algorithms which try to assess the cardiovascular risk of an individual. These scoring systems are based on the traditional risk factors that we all know well – lipids, smoking, hypertension, diabetes, family history of atherosclerotic cardiovascular disease (ASCVD), age and gender but unfortunately, we still don’t fully understand an individual’s susceptibility to the atherogenic vulnerability.…