29th January 2023, Dr Chee L Khoo
We have always regarded HDL-Cholesterol (HDL-C) as the good guys. In the 1970s, the Framingham Heart Study showed that HDL-C was negatively associated with the development of cardiovascular disease (CVD) (1). Thus, we have regarded HDL as anti-atherogenic lipoprotein and expected HDL-C-raising therapy to reduce CVD events. However, there have been recent reports of the associations of high HDL-C and osteoporosis and fractures in healthy older adults.…
29th January 2023, Dr Chee L Khoo
We looked at the difference in definitions between non-alcoholic and metabolic-dysfunction associated fatty liver disease (so-called NAFLD vs MAFLD) in the last issue of GPVoice. There are many similarities and overlap between the two entities. At the end of the day, does it really matter we call the diseases. Since writing the article, I have diagnosed quite a few MAFLD and taken the appropriate next steps in the management.…
4th January 2023, Dr Chee L Khoo
The term non-alcoholic fatty liver disease (NAFLD) was first coined by Ludwig in 1980. It was rather an exclusive diagnostic term to exclude the other liver disease from being included in the definition. If your liver disease relates to excessive alcohol intake, drugs or autoimmune conditions, it cannot be included in the diagnosis.…
4th January 2023, Dr Chee L Khoo
The most recent US Prevention Services Task Force (USPSTF) recommendations pour cold water onto its use in primary prevention of CVD in April 2022 (1). We explored the details and rationale behind that turnaround recently. The recommendation for use of aspirin for prevention of colorectal cancer is lumped in together with the recommendation for CVD prevention.…
29th December 2022, Spectrum Medical Imaging
Last week we explored coronary artery calcium score and looked at how the score is really more than a score. There is a lot more details than just a number in the report. Spectrum also has a team of subspecialist Cardiac Radiologists and Cardiologists who are trained in cardiovascular imaging interpretation. The report has details that allows us to proceed to the next stage of the cardiovascular risk assessment.…
24th December 2022, Dr Chee L Khoo
There have been a number of contentious safety concerns regarding the prolonged used of denosumab. The original FREEDOM trial demonstrated efficacy in reducing vertebral, hip and femoral fractures over 3 years of denosumab therapy. There was a further 7 years extension to the original trial and the report was published last year. There were some suggestions a few years ago that patients might, perhaps, need a drug holiday after 5-10 years on denosumab but there is increasing evidence of rapid reduction in bone densitometry (BDM) after denosumab is stopped.…
18th December 2022, Dr Chee L Khoo
Making a decision whether to treat patients with lipid lowering agents is relatively easy in patients who either have symptomatic cardiovascular (CV) disease or have a very low risk according to our CV risk assessment. It is a bit more difficult in the intermediate CV risk group. We have to consider the cost and adverse effects of initiating lifelong preventive therapy versus the potential benefit to the patient.…
12th December 2022, Dr Chee L Khoo
We explored lipoprotein a (Lp(a)) as a significant residual risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis in August this year. We looked at the strong and log-linear association between elevated Lp(a) and cardiovascular (CV) events. While the new PCSK9 inhibitors, notably alirocumab, has been shown to modestly reduce Lp(a) levels (and is associated with a small reduction in CV events) in the ODYSSEY trials, we do not have any agents that specifically lower Lp(a) approved yet (1).…
11th December 2022, Dr Chee L Khoo
You would have heard the exciting hype about lecanemab in the treatment of early Alzheimer’s disease. It’s all over the news and it is getting many patients excited. The Alzheimer’s disease community has become accustomed to false hope, disappointment, and controversy. Existing “treatments” of AD can hardly be called treatment as they can only slow down the progression of the disease (if it indeed work at all).…
24th November 2022, Dr Chee L Khoo
One of the problems in primary care in trying to keep up to date is that 1) there is just so many guidelines we need to keep track of 2) we don’t when the new guidelines are updated. It is often mentioned that, on average, it takes 16 years when guidelines are published before it lands on our desk and be adopted in practice.…
21st November 2022, Dr Chee L Khoo
Have you noticed that we don’t use the term “CCF” anymore. The heart doesn’t have to be congested (as in fluid overloaded) to be in failure. We think about how the heart is not performing to its best to pump blood to all parts of the body that requires bloods. We call that heart failure because the heart has “failed” to pump blood adequately to tissues requiring blood.…
14th November 2022, Dr Chee L Khoo
We all have patients with high triglycerides (TG) that warrant intensification of our lipid lowering treatment. Statins are efficacious in reducing total cholesterol (TC), increasing high density lipoprotein cholesterol (HDL-C) and reducing low density lipoprotein cholesterol (LDL-C). Statins also reduce triglycerides levels but often these patients have residual hypertriglyceridaemia that warrants the addition of a fibrate to get our TG to target.…