13th July 2022, Dr Chee L Khoo
In the last issue of GPVoice, we looked at the up-to-date guidelines in the management of dyslipidaemia in primary and secondary prevention. We looked at how complex those guidelines are. We also touched on the fact not all the evidence behind the guidelines is Level A evidence. The PCSK9 inhibitors, in particular, are a relatively new class of lipid lowering agents and the data is still coming in.…
13th July 2022, Dr Chee L Khoo
Have you noticed we don’t hear about congestive cardiac failure (CCF) anymore? Its’ just plain heart failure (HF) now. It makes sense because not all heart failures are congestive in nature. Of course, you are aware of the new terms – heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).…
26th June 2022, Dr Chee L Khoo
I was recently tasked with preparing a lecture on the current guidelines for lipid management in patients with diabetes. I thought it was quite straight forward. We have known for some years now that the targets are tighter than patients without diabetes. Thus, it can’t be that hard. As I looked into national and international guidelines, they started to get more and more complicated.…
13th June 2022, Dr Chee L Khoo
Fenofibrate is a commonly-used lipid lowering agent. In particular, it is recommended for patients with high triglycerides. Two previous studies have demonstrated that fenofibrate reduces the progression of diabetic retinopathy (DR) in patients who already have DR. Despite the benefits of fenofibrate, we don’t see recommendations for its use featured prominently in guidelines.…
12th June 2022, Dr Chee L Khoo
Non-alcoholic fatty liver disease (NAFLD) is the most common liver condition in the western world. A significant proportion of these patients developed inflammation and progressed to non-alcoholic steato-hepatitis (NASH). Further and persistent inflammation can lead to cirrhosis and ultimately, to liver failure or liver cancer. Management till recently is primarily targeted towards lifestyle measures to reduce liver fat.…
22nd May 2022, Dr Chee L Khoo
The close association of inflammation and cardiovascular disease is well known for some time. Inflammation is an essential mediator of all stages of atherosclerosis, from initiation to progression and the development of thrombotic complications (1,2). Circulating immune cells play a critical role in the build-up of atherosclerotic plaques by adhering to activated endothelium and infiltrating the arterial wall to become lesional cells (3).…
13th May 2022, Dr Chee L Khoo
Another month, another commonly used class of drugs are implicated in either aggravating glucose control in patients with type 2 diabetes (T2D) or actually, increase the risk of developing T2D. This month, we a report suggesting the use of proton pump inhibitors (PPIs), as a class of agent, is associated with increased risk of developing T2D.…
12th April 2022, Dr Chee L Khoo
We continue to see “routine” antibiotic cover for many surgical procedures. It is not uncommon to see antibiotic prophylaxis used in major surgery like open heart surgery, joint replacement surgery and bowel surgery but the list extends to sinus surgery, routine orthopaedic surgery and not that uncommonly, plastic reconstructive surgery. This is despite international guidelines stating that for clean and clean-contaminated procedures (explicitly including any prosthetic joint arthroplasty with or without a drain, additional prophylactic antimicrobial doses should not be administered after the surgical incision is closed in the operating room.…
8th April 2022, Dr Chee L Khoo
CVD is the major cause of mortality and morbidity in patients with type 2 diabetes (T2D). There are many hundreds of cardiovascular risk prediction tools around. Well, whenever you have many versions of a particular tool, it usually tells us that none of them are particularly good in what they are meant to do – that is to predict the risk of a cardiovascular event.…
12th March 2022, Dr Chee L Khoo
When you look at the management of patients with type 2 diabetes (T2D), almost all the patients are on a statin for both primary and secondary prevention of cardiovascular complications. I suspect that those that are not already on a statin should be on as some doctors are not aware of the tightened lipid targets in the management of patients with T2D.…
6th March 2022, Dr Chee L Khoo
This is about the potential cardiovascular complications after contracting covid-19 infection. It is coined “the Covid Heart”. A recent analysis of data from 154,000 US veterans one year out from their covid-19 infection have highlighted some scarry statistics. Naturally, you would expect that those who had more severe disease had higher risks of cardiovascular complications but these complications affect patients who are not hospitalised.…
27th February 2022, Dr Chee L Khoo
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.…