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


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.…

Testosterone replacement – is it cardio safe?

31st May 2024, A/Prof Chee L Khoo

Testosterone Replacement

It’s coming to almost 10 years now when suddenly, we were not able to prescribe testosterone replacement therapy (TRT) to men with hypogonadism or low testosterone levels under the PBS. This came on the back of a decision by the US FDA in March 2015 to restrict the prescription of TRT (1).…

The 4th Pillar in treatment of CKD

31st May 2024, A/Prof Chee L Khoo


Renin-angiotensin system (RAS) inhibitors and SGLT2 inhibitors have been the cornerstone treatment of chronic kidney disease (CKD) for many years now. They have been shown to protect kidneys and at the same time reduce adverse cardiovascular outcomes. Finerenone was recently shown to do the same. These three agents are now the guideline-directed three pillars in the treatment of CKD.…

Colchicine to reduce CVD – is it prime time yet?

12th May 2024, A/Prof Chee L Khoo


We are used to using colchicine for acute treatment of gout but colchicine has also proven itself a key pharmacotherapy in the treatment of cardiovascular conditions such as pericardial disease (1), post-operative atrial fibrillation (2) and coronary artery disease (3). Colchicine disrupts the inflammatory response in acute gout but the inflammatory pathways that colchicine acts on are also found in other inflammatory diseases including coronary artery disease.…

Ankle BP may predict future peripheral artery disease

27th April 2024, A/Prof Chee L Khoo

Ankle BP

PAD is associated with a high incidence of future lower-limb amputations, physical disability, cardiovascular outcomes, other serious health outcomes, reduced quality of life, and mortality (3–8). Some GPs are lucky to have tool that can easily perform ankle brachial index (ABI) as part of a cardiovascular assessment. It is a very simple tool that can detect peripheral arterial disease (PAD).…

Intermittent fasting – can it be harmful?

31st March 2024, A/Prof Chee L Khoo

Time restricted eating

In case you have not noticed, there was some disquiet in the cardiovascular community this week on the potential harm intermittent fasting can cause. The headline presentation says “8-hour time-restricted eating linked to a 91% higher risk of cardiovascular death”. Well, any study regarding “diets” are always going to be sus.…

Lipid lowering in T2D – what happens if you don’t treat to guidelines?

28th March 2024, A/Prof Chee L Khoo

We all know that high LDL-C is absolutely and adversely associated with cardiovascular mortality and morbidity. It’s been “proven” again and again in large clinical trials and meta-analyses after meta-analyses. Reducing lipids levels have also been shown to reduce cardiovascular (CV) events in secondary as well as in primary prevention. This is particularly the case in those with intermediate to high CV risks.…

MINOCA – an increasing cause of MI

10th March 2024, A/Prof Chee L Khoo

Acute MI

Myocardial infarction in a patient with minimal coronary artery disease (stenosis <50%) is increasingly being recognised in patients with myocardial injury but no significant coronary obstruction is demonstrated. Myocardial Infarction in Non-Obstructive Coronary Arteries (MINOCA) accounts for approximately 5-10% of all myocardial infarction. The precise pathogenesis is poorly understood. Diagnosing MINOCA is not straightforward and identifying the aetiologies and ongoing management can be challenging.…