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.…
13th August 2025, A/Prof Chee L Khoo
We know the ongoing cost and availability of anti-obesity medications (AOM) the likes of Wegovy and Mounjaro although we have been assured that the supply issue is behind us now. Part of the problem with cost relate to the manufacturing cost of the devices. In fact, the rate limiting step to the production is the pen, which needs to be precisely manufactured and tested as it is a medical device.…
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.…
11th June 2025, A/Prof Chee L Khoo
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).…
27th May 2025, A/Prof Chee L Khoo
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.…
24th May 2025, A/Prof Chee L Khoo
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).…
14th May 2025, NIA Diagnostic Imaging
Coronary artery calcium (CAC) scoring is a well-established, non-invasive imaging technique for assessing cardiovascular risk by identifying and quantifying calcified plaque in the coronary arteries. The CAC score, a direct marker of subclinical atherosclerosis, highly predicts future cardiovascular events, making it an essential tool for clinicians in assessing risk, even in asymptomatic individuals. (4, 5)
CAC scoring facilitates early identification of at-risk individuals by providing an objective assessment of coronary artery disease (CAD) burden, allowing for more targeted and proactive cardiovascular health care.…
27th April 2025, A/Prof Chee L Khoo
We recently looked at the LDL-C levels needed to stabilise plaque progression and the LDL-C levels needed to cause plaque regression. Plaque stabilisation and regression leads to reduction in cardiovascular events. Dyslipidaemia (especially LDL-C) is also associated with cognitive impairment and dementia and reducing those numbers with statin therapy reduces the risk.…
30th March 2025, A/Prof Chee L Khoo
While invasive coronary angiogram is still the gold standard in deciding whether revascularisation is indicated, invasive coronary angiogram has its limitations. That’s why intravascular ultrasound (IVUS) was invented. Well, it’s been 25-30 years since then and we have yet to have IVUS widely available for clinical use. We have additional miniaturised imaging techniques (see below later) since then and they are also not in clinical use as such.…