Familial hypercholesterolaemia is rare but what can it teach us?

27th February 2022, Dr Chee L Khoo

Hypercholesterolaemia

Homozygous familial hypercholesterolaemia (HoFH) is one of those conditions that allow us to prescribe the new PCSK9 inhibitors under PBS Authority. It is a pretty rare inherited disorder resulting in extremely elevated low-density lipoprotein cholesterol (LDL) levels and significantly elevated risk of premature atherosclerotic cardiovascular disease (ASCVD). Despite the extreme high risks, HoFH is usually go unrecognised and if recognised are diagnosed late and undertreated.…

Urolithin reduces aging effects – what is it?

13th February, 2021, Dr Chee L Khoo

getting older

One of the signs of getting old is that you are increasingly drawn to articles about efforts to reduce the effects of aging on health and age-related conditions. The positive effects of direct urolithin A (UA) administration in health, aging, and age-related conditions have been identified in several recent studies. UA is a gut microbiome derived natural compound that only 40% of people can naturally convert from dietary precursors at meaningful levels.…

Quadruple therapy for heart failure – no more excuses

27th January 2022, Dr Chee L Khoo

At GPVoice, we have covered the management of heart failure fairly comprehensively over the last couple of years. In particular, we explored the cardiovascular benefits of SGLT2 inhibitors in patients with type 2 diabetes (T2D) especially in patients with heart failure. Initial studies looked at patients with heart failure with reduced ejection fraction (HFrEF) although subsequent studies found the benefits was also seen in patients with preserve ejection fraction (HFpEF) although only empagliflozin has reported.…

Severe asthma – what is beyond triple therapy?

26th January 2022, Dr Chee L Khoo

severe asthma

How many reps have you seen recently promoting their bronchodilators? It’s all very confusing to me with the LAMA/LABA combo and now they have inhaled corticosteroids in the triple combo puffers. Who are these puffers for? Initially, they suggest triple therapy for COPD but they are now recommending the same for patients with severe asthma if the traditional LABA/ICS combo is not controlling the asthma.…

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

Cataracts

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.…