Adding aspirin to anti-coagulants – how safe is it?

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.…

Fitness and colorectal cancer – is there a connection?

23rd August 2025, A/Prof Chee L Khoo

Colorectal cancer

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).…

Creatine supplements – do they do anything?

22nd August 2025, A/Prof Chee L Khoo

Creatine

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?…

What happens if you do too much exercise?

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).…

HFpEF – what else can we use in addition to an SGLT2 inhibitor?

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.…

What happens if you become frail?

14th July 2025, A/Prof Chee L Khoo

Frail?

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.…

Who should not go vegan?

30th June 2025, A/Prof Chee L Khoo

There are many reasons why some of our patients go vegetarian. A primarily plant-based diet with less meat is supposed to lower the morbidity of chronic diseases, including cardiovascular diseases, type 2 diabetes, and certain cancers [1]. Some patients may choose to reduce their food-related ecological footprint. A transition to a diet that contains more plant-based products and less meat could increase food availability while releasing the burden on the environment [2].…

Papillary thyroid cancer – diagnosis and treatment

12th June 2025, NIA Diagnostic Imaging

Papillary thyroid carcinoma (PTC) is the most prevalent type of thyroid malignancy, accounting for approximately 75–90% of all thyroid cancer cases (Cozens, 2011; Solbiati et al., 2017). These tumours are typically slow-growing and display distinctive histologic features, including papillary structures, nuclear alterations, and multiple subtypes (Gonzalez-Gonzalez et al., 2011; Limaiem et al., 2023). The prognosis is generally favourable, with survival rates exceeding 90% and low mortality rates, ranging from 4–8% (Cozens, 2011; Solbiati et al., 2017).…

Atrial fibrillation – paradigm changes in management

11th June 2025, A/Prof Chee L Khoo

AF?

Atrial fibrillation (AF) is associated with 1.5 – 2-X risk of death (1,2), 2.4-X risk of stroke (2), 5-X risk of heart failure (HF) (2), 1.5-X risk of myocardial infarction (MI) (3), 2-X risk of sudden cardiac death (4), 1.6-X risk of chronic kidney disease (CKD) (2), 1.5-X risk of cognitive impairment or dementia (5) and 1.3-X risk of peripheral artery disease (PAD) (2).…

Hypertriglyceridaemia – limited options but …

27th May 2025, A/Prof Chee L Khoo

ASCVD

Hypertriglyceridaemia (HTG) causes and contribute to a number of serious medical conditions including pancreatitis, cardiovascular disease, MAFLD and worsening of type 2 diabetes. The efficacy and treatment options are complicated. Apart from treating any secondary causes, our treatment options are quite limited. Marine-derive omega-3 fish oils, fenofibrate and the new icosapent ethyl are all we have in our tool kit.…

New Acute Coronary Syndrome guidelines – is it relevant to GPs?

24th May 2025, A/Prof Chee L Khoo

Acute coronary syndrome (ACS)

One of the problems keeping up to date in primary care is not being aware of new guidelines that has been released. Well, the joint National Heart Foundation and Cardiac Society of ANZ released the new Australian clinical guideline for diagnosing and managing acute coronary syndromes (ACS) just a month ago (1).…