24th August 2024, A/Prof Chee L Khoo
Last fortnight we looked at the effects of hypertriglyceridaemia (HTG) on atherosclerosis. We explored the source and metabolism of triglycerides (TG). We saw how important lipoprotein lipase was in regulating plasma TG. Triglyceride levels are closely related to plasma triglycerides rich lipoprotein (TRL) and TRL remnants. All three components penetrate through the endothelium into the subendothelial space where atherosclerotic inflammation occur.…
24th August 2024, A/Prof Chee L Khoo
Plasma glucose levels is such a simple test that we take for granted its reliability. The glucose level is absolutely critical in many of our clinical management. It governs whether we diagnose someone with diabetes or not and that have many regulatory implications. We have discussed the diagnosis and management of gestational diabetes mellitus (GDM) and how it affects maternal and offspring outcomes and future risks to both.…
11th August 2024, A/Prof Chee L Khoo
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).…
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.…
25th July 2024, A/Prof Chee L Khoo
The current gold standard for screening for gestational diabetes mellitus (GDM) for women with no risk factors for hyperglycaemia is an oral glucose tolerance test (OGTT) at 24-28 weeks’ gestation. Women with risk factors are recommended to have an OGTT in the first trimester. Unfortunately, many women are nauseous during the first trimester and performing an OGTT during that time can be very unpalatable.…
21st July 2024, A/Prof Chee L Khoo
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.…
13th July 2024, A/Prof Chee L Khoo
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.…
12th July 2024, A/Prof Chee L Khoo
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.…
30th June 2024, A/Prof Chee L Khoo
Just in case you are not aware, there will be a tsunami of patients with metabolic dysfunction associate fatty liver disease (MAFLD) or metabolic dysfunction associated steatotic liver disease (MASLD) coming to you over the next few years. Part of the reason is to do with the better recognition of the condition and we are now detecting them more with biomarkers, imaging and a high index of suspicion.…
30th June 2024, A/Prof Chee L Khoo
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.…
10th June 2024, A/Prof Chee L Khoo
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.…
13th April 2024, A/Prof Chee L Khoo
We are all used to metformin being the first line glucose lowering agent when type 2 diabetes (T2D) is diagnosed. (Well, I know some you also use metformin before diabetes is diagnosed but that’s a different story). Glucose lowering efficacy of metformin is not that terrific as we now have much stronger glucose lowering agents available.…