27th December 2023, A/Prof Chee L Khoo
When we think about extreme physical activity (EPA) such as marathon running, apart from the perceived issue of wearing out knee and hip joints (that’s another issue, another day), we think about the cardiovascular risks or benefits that comes with this intense physical activity. We explored the issue of marathon running and cardiovascular risks 9 months ago here.…
27th December 2023, A/Prof Chee L Khoo
Not surprisingly, if dysglycaemia is the major contributor to microvascular complications in type 2 diabetes (T2D), the same complications must plaque our patients with type 1 diabetes (T1D. However, we haven’t had many major advances in the management for chronic kidney disease (CKD) and cardiovascular disease (CVD) in patients with T1D for decades.…
12th December 2023, NIA Diagnostic Imaging
One of the standout diagnoses I remember from medical school is renal artery stenosis. In practice, it is usually someone else that makes that diagnosis. It is not that uncommon. We may hear an abdominal bruit in our general vascular screen. We might struggle to get our patient’s BP to target despite the 4th or 5th agent.…
9th December 2023, A/Prof Chee L Khoo
We know how effective statins are in lowering cholesterol levels. Lowering of cholesterol levels, especially LDL-C, have been shown to incrementally reduce adverse cardiovascular events in patients with atherosclerotic disease. We have data to show that for every 1 mmol/L of LDL-C reduction there is a 23% reduction in cardiovascular events, which means, the lower the better (1).…
11th October 2023, Dr Chee L Khoo
Aspirin is commonly used as an anti-platelet agent for the prevention of acute coronary syndromes and cerebrovascular accidents. Its role in secondary prevention is well established but its role in primary prevention remains very complicated and very debatable. There is no question that aspirin is definitely beneficial in reducing events especially in patients at high risk of cardiovascular events.…
11th October 2023, Dr Chee L Khoo
Current U.S. dietary guidelines do recommend higher intake of omega-6 polyunsaturated fatty acids (n-6 PUFA) to reduce the risk of coronary heart disease (1,2). This pro-Omega-6 fatty acid stance remains rather contentious. While there is data supporting cholesterol benefits of linoleic acid (LA), the predominant dietary n-6 PUFA and higher dietary n-6 PUFA (predominantly LA) is associated with lower CHD risk in prospective cohort studies (3), not all cohort studies have confirmed these benefits (4).…
28th September, 2023, Dr Chee L Khoo
In June this year, we saw how our understanding of the pathophysiology of hypertrophic cardiomyopathy (HCM) (formerly known as hypertrophic obstructive cardiomyopathy or HOCM) has significantly changed. In particular, we saw how not all patients with HCM have “obstruction” in the left ventricular tract. In other words, the primary defect in HCM is no longer “structural”.…
26th July 2023, Dr Chee L Khoo
It is coming up to 10 years now when we, as GPs, were suddenly not allowed to prescribe TRT for our patients with low serum testosterone levels. The rationale cited at the time was that testosterone replacement therapy (TRT) was potentially harmful because we were told that TRT is associated with increased cardiovascular risk in men with hypogonadism.…
12th July 2023, Dr Chee L Khoo
The WHO define biological markers or biomarkers as “any substance, structure or process that can be measured in the body or its products and influence or predict the incidence of outcome or disease”. In heart failure, many biomarkers have been studied but B-type natriuretic peptide (BNP) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) come close to the characteristics of “ideal” heart failure (HF) biomarkers.…
12th July 2023, Dr Chee L Khoo
It’s almost a year since we foreshadowed the arrival of finerenone and it’s finally on the PBS, albeit with the usual and expected very restricted criteria. We discussed finerenone’s impressive cardiovascular and renal outcomes in patients with heart failure and chronic kidney disease. We further discussed why finerenone is a better mineralo-corticosteroid receptor antagonist (MRA) than what we have at the moment, spironolactone and eplenerone.…
25th June 2023, Dr Chee L Khoo
Consensus cardiology recommendations previously supported the ’blanket’ disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. Clinically, it is almost impossible to exclude HCM from physical examination. Thus, sudden cardiac death (SCD) is always on our minds when we are asked to sign off on a clearance to participate in sporting activities.…
29th April 2023, Dr Chee L Khoo
We have a increasing number of patients who has undergone a percutaneous coronary intervention (PCI). This could be in the acute setting of an acute coronary syndrome (ACS) or electively during an exploratory angiogram. Stents used to be bare metal. Then came the first-generation drug eluting stents. The latest generation drug eluting stents are better at reducing subsequent thrombosis of the stented and unstented coronary segments.…