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).…
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.…
13th October 2022, Dr Chee L Khoo
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.…
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.…
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?…
9th September 2022, Dr Chee L Khoo
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).…
29th August 2022, Dr Chee L Khoo
By now, you would be very familiar with the additional cardiorenal benefits when you use an SGLT2 inhibitor (SGLT2i) in the management of hyperglycaemia in patients with type 2 diabetes (T2D). You would also know that the benefits are enjoyed by patients whether they have diabetes or not. DAPA-CKD published in September 2020 during the pandemic.…
14th August 2022, Dr Chee L Khoo
We all know that regular physical activities is associated with lower ill-health and mortality and better quality of life. International guidelines suggest adults perform from 150 to 300 minutes per week (min/wk) of moderate-intensity aerobic physical activity, 75 to 150 min/wk of vigorous-intensity aerobic physical activity, or an equivalent combination of both intensities (1).…
30th July 2022, Spectrum Medical Imaging
Up to 31%-69% of COVID-19 survivors will experience long COVID symptoms after initial recovery from SARS-CoV-2 infection [1, 2]. While the initial symptoms of long COVID symptoms include fatigue (29%), muscle pain, palpitations, cognitive impairment (28%), dyspnea (21%), anxiety (27%), chest pain, and arthralgia (18%) [3], in patients experiencing long covid symptoms, fatigue is most prevalent (51%), followed by dyspnoea (35%), arthralgia (25%) and concentration difficulties (25%).…