Singapore medical journal最新文献

{"title":"Low-density lipoprotein cholesterol goal attainment and mortality in ischaemic heart disease: a two-year observational study.","authors":"Ying Hui Mak, Fionn Chua, Xuan Han Koh, Vern Hsen Tan, Zhong Hui Lee, Audrey Lam, Kim Leng Tong, Colin Yeo, Weien Chow, Wann Jia Loh","doi":"10.4103/singaporemedj.SMJ-2024-172","DOIUrl":"10.4103/singaporemedj.SMJ-2024-172","url":null,"abstract":"<p><strong>Introduction: </strong>Achieving low-density lipoprotein cholesterol (LDL-C) levels is key to preventing atherosclerotic cardiovascular events. However, many high-risk cardiovascular patients still experience poor LDL-C goal attainment and receive suboptimal lipid-lowering therapy (LLT) prescriptions. Herein, we evaluated LLT prescription patterns, LDL-C goal attainment and cardiovascular mortality among this population group in Singapore.</p><p><strong>Methods: </strong>This prospective observational cohort study included 555 patients with ischaemic heart disease (IHD) admitted to the hospital in 2020. The LLT prescriptions, corresponding LDL-C levels and cardiovascular outcomes were assessed over a 24-month period.</p><p><strong>Results: </strong>Most participants were male (82.3%), with 48.5% identified as Chinese. High-intensity statin prescriptions increased from 45.4% at hospital admission to 87.1% at discharge and remained stable at approximately 80% at 6, 12, and 24 months post-discharge. Combination LLT prescriptions increased from 12.3% at discharge to 33.8% by 24 months. Ezetimibe was the most commonly prescribed second-line LLT (40.8%), followed by inclisiran (1.09%) and anti-proprotein convertase subtilisin/kexin type 9 monoclonal antibody therapies (0.87%). Over 24 months, LDL-C goal attainment rates were 22.1% for LDL-C < 1.4 mmol/L and 47.2% for LDL-C < 1.8 mmol/L. Multivariable Cox proportional hazards regression indicated that achieving LDL-C < 1.8 mmol/L goal was associated with a reduction in all-cause mortality at 24 months (hazard ratio 0.53, 95% confidence interval 0.30-0.94, P = 0.030).</p><p><strong>Conclusion: </strong>Treatment gaps in lipid management persist in 80% of the study population, indicating that statin monotherapy alone is insufficient to achieve LDL-C goals. Greater efforts to improve LDL-C goal attainment rates in high-risk cardiovascular patients are imperative.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 3","pages":"154-162"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular-obstetric state-of-the-art review: pulmonary hypertension in pregnancy.","authors":"Joy Yi Shan Ong, Jeannie Jing Yi Yap, Mahesh Choolani, Kian-Keong Poh, Pradip Dashraath, Ting-Ting Low","doi":"10.4103/singaporemedj.SMJ-2024-198","DOIUrl":"10.4103/singaporemedj.SMJ-2024-198","url":null,"abstract":"<p><strong>Abstract: </strong>Pulmonary hypertension in pregnancy has been associated with negative maternal and fetal outcomes over the past decades. With the emergence of novel treatment modalities, morbidity and mortality of women who have pulmonary hypertension in pregnancy have improved. In this review, we aim to explore the contemporary updates in the management of pre-capillary and post-capillary pulmonary hypertension in pregnancy.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 3","pages":"130-140"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic kidney disease is no longer a 'non-traditional' cardiac risk factor: a call to action for cardiovascular-kidney-metabolic health.","authors":"Jie Ming Nigel Fong, Ching-Hui Sia, Kay Choong See","doi":"10.4103/singaporemedj.SMJ-2025-012","DOIUrl":"10.4103/singaporemedj.SMJ-2025-012","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 3","pages":"122-124"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing cardiovascular health: prevention, risk management and emerging insights.","authors":"Kian-Keong Poh, Ching-Hui Sia","doi":"10.4103/singaporemedj.SMJ-2025-035","DOIUrl":"10.4103/singaporemedj.SMJ-2025-035","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 3","pages":"120-121"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiology in the community: integrating care through professional communication in Singapore.","authors":"Toon Wei Lim, Yee Wei Lim","doi":"10.4103/singaporemedj.SMJ-2024-164","DOIUrl":"10.4103/singaporemedj.SMJ-2024-164","url":null,"abstract":"","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 3","pages":"127-129"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between bone mineral density and vascular health in rheumatoid arthritis.","authors":"Chuanhui Xu, Yi Wye Lai, Shih-Huan Chou, Xiaoe Zhang, Ee Tzun Koh, Rinkoo Dalan, Khai Pang Leong","doi":"10.4103/singaporemedj.SMJ-2024-183","DOIUrl":"10.4103/singaporemedj.SMJ-2024-183","url":null,"abstract":"<p><strong>Introduction: </strong>Rheumatoid arthritis (RA) is associated with heightened cardiovascular disease and increased susceptibility to osteoporosis, with shared underlying mechanisms. This study aimed to investigate the association between vascular function and bone mineral density (BMD).</p><p><strong>Methods: </strong>We conducted a cross-sectional study of 49 patients with RA at Tan Tock Seng Hospital, Singapore. Endothelial function was measured as reactive hyperaemia index (RHI)-endothelial peripheral arterial tonometry and aortic stiffness as carotid-femoral pulse wave velocity (cf-PWV) using SphygmoCor. Univariable and multivariable linear regression analyses were performed to evaluate the associations between BMD and vascular function. We used natural logarithm RHI (lnRHI) and cf-PWV as response variables, and each BMD as covariate, adjusting for body mass index, positive anti-cyclic citrullinated peptide, cumulative prednisolone dose, hydroxychloroquine use and Systematic COronary Risk Evaluation 2.</p><p><strong>Results: </strong>We recruited 49 patients (mean age 61.08 ± 8.20 years), of whom 44 (89.80%) were women and 39 (81.25%) were Chinese. Significant associations were found between lnRHI and BMD at the lumbar spine (β = 0.4289, P = 0.037) and total hip (β = 0.7544, P = 0.014) in univariable analyses. Multivariable analyses confirmed these associations, showing that lower BMD at the lumbar spine (β = 0.7303, P = 0.001), femoral neck (β = 0.8694, P = 0.030) and total hip (β = 0.8909, P = 0.010) were significantly associated with worse lnRHI. No significant associations were found between BMD and cf-PWV.</p><p><strong>Conclusion: </strong>Lower BMD is associated with endothelial dysfunction, but not aortic stiffness in patients with RA. Further longitudinal studies are needed to confirm these associations and understand the underlying mechanisms.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 3","pages":"147-153"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frontiers in subclinical atherosclerosis and the latest in early life preventive cardiology.","authors":"Mayank Dalakoti, Ching Kit Chen, Ching-Hui Sia, Kian-Keong Poh","doi":"10.4103/singaporemedj.SMJ-2024-169","DOIUrl":"10.4103/singaporemedj.SMJ-2024-169","url":null,"abstract":"<p><strong>Abstract: </strong>Subclinical atherosclerosis underlies most cardiovascular diseases, manifesting before clinical symptoms and representing a key focus for early prevention strategies. Recent advancements highlight the importance of early detection and management of subclinical atherosclerosis. This review underscores that traditional risk factor levels considered safe, such as low-density lipoprotein cholesterol (LDL-C) and glycated haemoglobin (HbA1c), may still permit the development of atherosclerosis, suggesting a need for stricter thresholds. Early-life interventions are crucial, leveraging the brain's neuroplasticity to establish lifelong healthy habits. Preventive strategies should include more aggressive management of LDL-C and HbA1c from youth and persist into old age, supported by public health policies that promote healthy environments. Emphasising early education on cardiovascular health can fundamentally shift the trajectory of cardiovascular disease prevention and optimise long-term health outcomes.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":"66 3","pages":"141-146"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity of patients with rheumatoid arthritis in Singapore: a pilot study.","authors":"Andre Jin Wei Loh, Ee Lynn Ting, Yu Heng Kwan, Ting Hui Woon, Jie Kie Phang, Chin Teck Ng, Warren Fong","doi":"10.4103/singaporemedj.SMJ-2023-167","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2023-167","url":null,"abstract":"<p><strong>Introduction: </strong>Studies have shown that patients with rheumatoid arthritis (RA) have lower levels of physical activity (PA) than healthy controls, despite the benefits of PA in reducing pain and stiffness. We aimed to compare the levels of PA in patients with RA with that of the general population and identify factors associated with meeting the World Health Organization (WHO) recommendations for PA.</p><p><strong>Methods: </strong>Consecutive patients with RA were recruited from an outpatient rheumatology clinic in a tertiary hospital in Singapore. Data for the general population were obtained from the Singapore Health 2012 study. To obtain comparable controls from the general population, we performed propensity score matching based on age and gender.</p><p><strong>Results: </strong>Sixty patients with RA were recruited. The proportions of patients with RA and controls who met WHO recommendations for PA were similar (78.3% vs. 80.0%, P = 0.82). After propensity matching, patients with RA spent significantly less time on work-related PA compared to controls (54.3 ± 147.4 min vs. 73.0 ± 132.6 min, P < 0.01). Disease activity was insignificant in determining whether WHO recommendations for PA were met in patients with RA. In the multivariable logistic regression, being employed (odds ratio 4.72, 95% confidence interval 1.20-18.59) was associated with meeting WHO recommendations.</p><p><strong>Conclusions: </strong>In this study, the proportion of patients with RA who met the recommendations for PA was similar to that of controls after propensity score matching. Among patients with RA, being employed was associated with meeting WHO recommendations for PA.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions and attitudes of kidney transplant recipients towards SARS-CoV-2 vaccination: a single-centre study.","authors":"Jian Shiun Tan, Anantharaman Vathsala, Hersharan Kaur Sran, Matthew Ross D'Costa, Zi Yun Chang, Emmett Tsz Yeung Wong","doi":"10.4103/singaporemedj.SMJ-2024-107","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-107","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney transplant recipients are at increased risk of severe outcomes from coronavirus disease 2019. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination has been shown to reduce hospitalisation and mortality rates in kidney transplant recipients, but vaccine hesitancy remains a concern. We surveyed kidney transplant recipients in a single centre to examine their perceptions and attitudes towards SARS-CoV-2 vaccination.</p><p><strong>Methods: </strong>A cross-sectional survey of kidney transplant recipients was conducted between June 2021 and August 2021. Questionnaire responses collected included demographic data, intention to receive SARS-CoV-2 vaccine and factors related to vaccine acceptance or hesitance. Predictors and reasons for vaccine acceptance were analysed.</p><p><strong>Results: </strong>In the sampled cohort of 313 respondents, the vaccine acceptance rate was 75%; 61% of the respondents were aged 51-70 years, and 31% had transplant vintages of 10-20 years. In a multivariable model, transplant physicians' recommendation (odds ratio [OR] 4.1, 95% confidence interval [CI] 2.4-7.1, P < 0.001), male gender (OR 2.3, 95% CI 1.3-4.0, P = 0.003) and transplant vintage of <10 years (OR 2.0, 95% CI 1.2-3.5, P = 0.01) were predictors of vaccine acceptance. Recipients' perceptions that SARS-CoV-2 vaccination confers protection and their trust in the government and health authorities on vaccine efficacy and safety were reasons for vaccine acceptance, while concerns about the effects of vaccination on allograft function and the safety and efficacy of vaccines were reasons for vaccine hesitancy. Assurance from transplant physicians played an important role in increasing vaccine acceptance.</p><p><strong>Conclusion: </strong>A high level of knowledge and trust in the doctor-patient relationship remain critical for kidney transplant recipients to improve vaccine acceptance. Continued efforts are required to address concerns about vaccine efficacy and safety in this population.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Asian monogenic diabetes registry: prevalence, long-term renal trajectory and development of a diagnostic algorithm for selection of candidates for genetic testing.","authors":"Clara Si Hua Tan, Kai Xiang Kee, Huili Zheng, Lovynn Wan Ting Chan, Yuzhen Song, Winston Yin Chian Kon, Ying Jie Chee, Joyce Xia Lian, Rashida Farhad Vasanwala, Fabian Kok Peng Yap, Wann Jia Loh, Tavintharan Subramaniam, Chee Fang Sum, Su Chi Lim","doi":"10.4103/singaporemedj.SMJ-2024-012","DOIUrl":"https://doi.org/10.4103/singaporemedj.SMJ-2024-012","url":null,"abstract":"<p><strong>Introduction: </strong>Through the National Healthcare Group-Khoo Teck Puat Hospital Monogenic Diabetes Registry, we aimed to determine the prevalence and spectrum of maturity-onset diabetes of the young (MODY), describe the long-term renal trajectory of major MODY subtypes, and develop a diagnostic algorithm based on a combination of clinical parameters and biomarkers to refine selection of candidates for genetic testing.</p><p><strong>Methods: </strong>A total of 373 study participants attending secondary care diabetes centres in Singapore were referred for genetic testing. Key inclusion criteria for genetic testing included onset age ≤35 years, body mass index <32.5 kg/m2 and absence of glutamic acid decarboxylase autoantibody.</p><p><strong>Results: </strong>Analysis of 16 genes and one mitochondrial variant led to a molecular diagnosis in 49 participants, with pathogenic variants present mostly in HNF1A (29%), HNF4A (23%) and GCK (15%). Long-term renal trajectory data observed between these major MODY subtypes were not significantly different, but some key observations were typical for each subgroup. For instance, patients with HNF4A-MODY were predisposed to the risk of microvascular complications (i.e., diabetic kidney disease), while patients with GCK-MODY had mild and non-progressive hyperglycaemia. A structured diagnostic algorithm, including readily available biomarkers such as high-sensitive C-reactive protein (hs-CRP) and high-density lipoprotein-cholesterol (HDL-c), provided 71% diagnostic accuracy, achieving a negative predictive value of 0.94 and a sensitivity of 0.68.</p><p><strong>Conclusion: </strong>The prevalence of MODY (13%) is non-trivial among young-onset diabetes referred for genetic testing based on clinical classifiers suggestive of MODY. Current clinical assessment tools may include hs-CRP and HDL-c to refine selection of candidates for genetic testing.</p>","PeriodicalId":94289,"journal":{"name":"Singapore medical journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}