Colorectal cancer – is aspirin any good in prevention?

CRC

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.…

Coronary artery calcium score – who do you trust?

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.…

Denosumab – how long can you be on it for?

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.…

Coronary artery calcium score – more than just a score

18th December 2022, Dr Chee L Khoo

CAC score

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.…

Elevated Lipoprotein a – what are the treatment options?

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).…

Lecanemab for early Alzheimer’s – does it really work?

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).…

HF management in general practice – do we have to wait for the cardiologist?

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.…

Omega-3 supplements – a fishy tale just got more fishy

14th November 2022, Dr Chee L Khoo

fish oil supplements

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.…

Ceramides – the new monster in dyslipidaemia

13th October 2022, Dr Chee L Khoo

ceramides

Obesity, type 2 diabetes mellitus (T2D), fatty liver disease, and cardiovascular disease (CVD) are complex and very inter-related cardio-metabolic conditions. Most of these conditions have lipids derangements as a major contributor to complications. While the link between lipids, in particular LDL-C, and CVD is linear and robust, there is still residual risks after aggressive treatment with lipid lowering agents.…

Finerenone is coming – what is finerenone?

13th October 2022, Dr Chee L Khoo

Patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) are not only more likely to progress towards renal failure requiring dialysis or renal transplant, but also have a greater lifetime risk of cardiovascular (CV) morbidity and mortality (1). This is not surprising though, as both the kidneys and the heart share the same pathophysiology.…

Dapagliflozin just DELIVERed its findings – new paradigm in HF treatment?

HF

25th September 2022, Dr Chee L Khoo

We looked at the Australian guidelines on management of heart failure (HF) recently and in particular, how it impacts upon the management of these patients in primary care. The guidelines recommended the four pillars of management but also reinforced the categories of HF. Did you know that the numbers that define the different categories of HF is somewhat arbitrary?…

To aspirin or not to aspirin for primary CVD prevention

9th September 2022, Dr Chee L Khoo

Aspirin

While aspirin does provide a modest benefit in reducing nonfatal MI and nonfatal stroke events, low dose aspirin has little or no effect on cardiovascular disease mortality or all-cause mortality in patients who have not had cardiovascular disease (1). In 2016, the US Preventive Services Task Force (USPSTF) concluded that the beneficial effect of aspirin for the primary prevention of CVD was modest and occurred at doses of 100 mg or less per day (2).…