11th November, A/Prof Chee L Khoo
Don’t we all hate the onerous restrictions on the PBS Authority criteria to qualify for the PCSK9 therapy. The efficacy of the agents (evolocumab, alirolocumab and inclisran) is well proven in clinical trials (1-3). Only the -mabs have to shown to have cardiovascular benefits. CV outcomes is yet to be established with inclisiran. The main reason for the onerous restrictions is primarily related the typical patients in those clinical trials.…
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.…
31st October 2025, A/Prof Chee L Khoo
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.…
11th October 2025, A/Prof Chee L Khoo
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.…
29th September 2025, A/Prof Chee L Khoo
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.…
29th September 2025, A/Prof Chee L Khoo
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.…
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.…
23rd August 2025, A/Prof Chee L Khoo
Not very often do you come across two significant studies on the same topic within weeks of each other. Over the last two months, two very interesting trials reported on the influence of exercise and fitness on risk of colorectal cancer (CRC) and the risk of recurrence of CRC. We know that being overweight or obese confer significantly higher risks of at least 13 different cancers (1,2).…
22nd August 2025, A/Prof Chee L Khoo
We always worry when athlete patients take supplements to improve their workout and performance. We don’t really know what these “supplements” are. We don’t really know whether they work or whether they are safe. One of the most commonly used supplements is creatine. Does it help muscle building and performance? Does it help to lose fat?…
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).…
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.…
14th July 2025, A/Prof Chee L Khoo
It’s amazing how we have learnt to accept declining muscle function and increasing frailty as part of our patients getting older. At GPVoice, we have explored muscle health and sarcopenia many times over the couple of years. We know that declining muscle health is associated not only with falls risk but also with increase mortality rates in COPD, heart disease, osteoporosis and post surgical outcomes.…