Aspirin for Primary Prevention

May 6, 2022 Andrew To

Aspirin use in primary prevention is controversial, contrasting that of secondary prevention. It may offer benefit in some, but for most, risk-benefit analysis may argue against its use. Here is the discussion.

BP therapy initiation - Combination vs. Single Agent

September 4, 2019 Andrew To

Expected BP lowering with different anti-hypertensive classes and dosages.

65M with Type 2 diabetes on oral hypoglycaemics but no proven coronary artery disease, BP 150/95mmHg despite 3 months of intensive lifestyle modifications, not currently on anti-hypertensives. Would you?

- Introduce low dose ACE inhibitors, with gradual up-titration

- Introduce combination ACE inhibitor / thiazide, with up-titration later on

Alcohol consumption risk thresholds

August 6, 2018 Andrew To

Despite apparent “benefit” for heart attacks, increasing levels of alcohol consumption increase the risk of all-cause mortality and of cancers specifically, meaning that the level of consumption that minimises health loss is probably zero. At most, 100g per week is the absolute maximum before which risk increases significantly.

Lifestyle changes for hypertension – exactly how effective is it?!

April 19, 2018 Andrew To

In general practice (and in secondary care), we discuss at length lifestyle modifications that aid blood pressure lowering. But exactly how effective are the various strategies?

There are 5 things we could do to reduce our blood pressure, without medications.

Patient centered discussion of primary prevention statin therapy

September 5, 2017 Andrew To

The Mayo clinic has recently published an electronic tool called “Statin Choice Decision Aid”, which is immensely valuable in helping patients visualize cardiovascular risk, and the benefit of statin medications as applied to them.