Prostate cancer and statins – a complex relationship

25th December 2021, Dr Chee L Khoo

PSA screening

There is increasing evidence that supports an inverse association between statin use and cancer risk. The findings for prostate cancer, particularly advanced disease, are the most promising of all cancers studied. There are studies suggesting the usefulness of statins in secondary and tertiary prevention. For example, patients undergoing radiotherapy for prostate cancer improved their prostate specific survival if they are on statins.…

Cataract surgery delay – does it contribute to dementia risk?

11th December 2021, Dr Chee L Khoo


Cataract is a leading cause of blindness worldwide, affecting more than 35 million people globally and causing blindness in approximately 20 million. Visual impairment is an important dementia risk. Addressing sensory loss from visual impairment that affects older adults may be a potentially modifiable risk factor for dementia in late life (1,2) Because sensory impairments and dementia are both strongly associated with aging the link between sensory impairment and dementia may have important implications for individual and global public health, particularly if interventions to improve sensory function reduce dementia risk (3).…

Micro-AF – harbinger of AF?

29th November 2021, Dr Chee L Khoo

One of our biggest fears is missing an atrial fibrillation (AF) and patient is discharged from hospital following their first embolic stroke. Almost all the automatic sphygmomanometers do not check for cardiac rhythm and I make it a point to put a finger on the pulse each time to make sure patients are in sinus rhythm.…

PCSK9 inhibitors on the PBS – another kid on the block

13th November 2021, Dr Chee L Khoo

PBS Authority for PCSK9 inhibitors

The authority to prescribe a PCSK9 inhibitors for patients with resistant hyperlipidaemia under the PBS continues to be pretty complicated. We tried to simplified those numerous criteria back in December 2020 here when the criteria were “loosened” somewhat. This has facilitated my prescription of this important drug in those patients who have really, really high cardiovascular risk.…

Dyslipidaemia in young adults – should we be treating?

2nd October 2021, Dr Chee L Khoo

cumulative high lipids

We generally see two categories of patients with high lipids, one who had normal lipids earlier on in life but developed high lipids later in life because of modern living and one whose lipids were already high when they were young (and slim and fit). Most of the scientific studies linking high lipids with cardiovascular (CV) events look at lipid levels at a snap point in time, at enrolment and the follow up period just aren’t long enough.…

DOAC for valvular AF – is that allowed?

11th September 2021, Dr Chee L Khoo

stroke prevention in AF

You may recall when direct acting oral anti-coagulants (DOAC) first came out for treatment of atrial fibrillation (AF). Upon diagnosis of new AF, some GPs were hesitant to initiate a DOAC for the AF but instead refer patients to a cardiologist. There is a danger while waiting to see the cardiologist that the patient may incur a cerebrovascular accident (CVA).…

Neurodegenerative diseases – the role of glymphatics

10th July 2021, Dr Chee L Khoo

neurodegenerative disorders

In medical school, we were taught that the cerebral spinal fluid (CSF) provides the brain with nutrients, transports catabolites and the blood brain barrier (BBB) keeps nasties out and maintains a stable environment (homeostasis). Now, keeping nasties out is great but how does the brain get rid of the waste it generates?In the last fortnight, we explored how the brain cleans itself of toxic and waste products.…

Glymphatic system – the brain’s lymphatic system

25th June 2021, Dr Chee L Khoo

Where are the lymphatics?

The human circulatory system processes about 20 litres of blood per day through capillary filtration. About 17 litres of the filtered plasma is reabsorbed directly into the blood vessels while the remaining three litres are left in the interstitial fluid. One of the main functions of the lymphatic system is to provide an accessory return route to the blood for that surplus three litres as well as clearance of waste products.…

Newer anti-epileptic drugs in pregnancy – how safe are they?

12th June 2021, Dr Chee L Khoo

More than 50 years ago, there were reports of association between anti-epileptic drugs (AEDs) and birth defects (1). We now have newer AEDs including carbamazepine, lamotrigine, phenytoin and levetiracetam. In 2016, the UK banned valproate use in women who are not in a pregnancy prevention programme.  Despite that, sodium valproate is still widely prescribed in many countries to women of childbearing age.…

SGLT2 inhibitors in heart failure – it’s almost an emergency!

22nd May 2021, Dr Chee L Khoo


Clinical inertia in heart failure (HF) treatment means deferred initiation of additional proven beneficial therapy, which ultimately leads to preventable adverse HF events. Hospitalisation for worsening HF is a prognostically significant event in the clinical course of a patient with chronic HF (1,2). Hospitalisation for HF (hHF) identifies patients who are at high risk for subsequent disease progression, requirement for advanced therapies, and cardiovascular death.…