I would like to express my sincere gratitude to Servier Malaysia for the invitation to participate in the recent Connect With Experts educational meeting alongside Dr Teh Wai Bin, Consultant Paediatrician from KPJ Puteri Hospital.
It was a privilege to share insights during my session, “The Marathon to Achieve the Goal, Maintain Control,” where we explored real-world cardiovascular cases and discussed practical approaches to achieving and sustaining treatment goals.
One of the key messages from the session was that cardiovascular risk management is a lifelong journey. While advances in medicine have provided us with effective tools to control blood pressure, cholesterol, diabetes, and other risk factors, long-term success depends on consistent patient engagement, adherence to treatment, and regular follow-up.
The interactive discussions highlighted several important themes:
✅ Early identification and management of cardiovascular risk factors ✅ Individualised treatment strategies tailored to each patient’s needs ✅ The importance of maintaining control rather than simply achieving short-term targets ✅ Shared decision-making between healthcare professionals and patients ✅ Lifestyle modification as the foundation of cardiovascular prevention
The lively exchange of experiences and perspectives among healthcare professionals made the session particularly rewarding. These discussions reinforce the importance of continuous medical education and collaboration in improving patient outcomes.
Thank you to all colleagues who attended and contributed to the discussion. I look forward to future opportunities to learn, share, and work together towards better cardiovascular care for our patients.
For decades, cardiologists have focused on one goal: lowering LDL cholesterol (“bad cholesterol”) to prevent heart attacks and strokes.
Yet despite high-intensity statins, ezetimibe, and lifestyle modification, many patients with Atherosclerotic Cardiovascular Disease (ASCVD) still fail to achieve guideline-recommended LDL-C targets.
“How low can we safely go, and how can we keep LDL cholesterol low for life?”
This is where Sybrava (siRNA therapy) enters the game.
What is ASCVD?
ASCVD refers to conditions caused by cholesterol plaque build-up inside arteries, including:
Previous heart attack
Coronary artery disease
Coronary stenting (PCI)
Coronary bypass surgery
Stroke
Peripheral arterial disease
Once a patient develops ASCVD, they remain at very high cardiovascular risk for the rest of their life.
Think of ASCVD as a marathon, not a sprint.
Every year that LDL cholesterol remains elevated is another opportunity for plaque progression and future cardiovascular events.
Why LDL Cholesterol Matters
LDL cholesterol is one of the strongest drivers of plaque formation.
Numerous studies have consistently shown:
✔ Lower LDL-C = Lower risk of heart attack
✔ Lower LDL-C = Lower risk of stroke
✔ Lower LDL-C = Lower cardiovascular mortality
Current international guidelines recommend:
LDL-C Targets
Very High-Risk ASCVD Patients
LDL-C < 1.4 mmol/L (<55 mg/dL)
Extremely High-Risk Patients
LDL-C < 1.0 mmol/L (<40 mg/dL)
The challenge?
Many patients remain above target despite maximal statin therapy.
The Problem with Traditional Cholesterol Treatment
While statins remain the foundation of therapy, several real-world issues exist:
1. Poor Medication Adherence
Many patients forget daily medications.
Missing tablets leads to fluctuating LDL levels and loss of protection.
2. Statin Intolerance
Some patients develop:
Muscle aches
Fatigue
Elevated liver enzymes
Although true statin intolerance is uncommon, it remains a barrier.
3. Persistent Residual Risk
Even patients on high-dose statins may not reach LDL targets.
Additional therapies are often required.
What is Sybrava (siRNA Therapy)?
Sybrava utilizes small interfering RNA (siRNA) technology.
Instead of simply blocking cholesterol production, siRNA works at the genetic messenger level.
It targets the production of PCSK9, a protein responsible for LDL receptor degradation.
When PCSK9 is reduced:
✅ More LDL receptors remain active
✅ The liver removes more LDL cholesterol from circulation
✅ LDL cholesterol falls significantly and sustainably
Why siRNA Technology is Different
Imagine LDL receptors as vacuum cleaners removing cholesterol from your bloodstream.
PCSK9 acts like a worker that keeps throwing those vacuum cleaners away.
Sybrava reduces the production of PCSK9.
As a result:
More LDL receptors survive
More cholesterol is cleared
LDL-C remains low for prolonged periods
This represents a completely different treatment strategy from traditional statins.
Key Benefits of Sybrava
Sustained LDL Reduction
One of the most exciting features is long-lasting LDL-C lowering.
Patients do not need to remember daily medication for this specific mechanism.
Consistent Cholesterol Control
Unlike daily tablets that can be missed, LDL lowering remains more stable over time.
Complementary to Statins
Sybrava is not necessarily a replacement for statins.
Instead, it may work alongside:
Statins
Ezetimibe
Other lipid-lowering therapies
to achieve aggressive LDL targets.
Why “Lower is Better” in ASCVD
Large cardiovascular outcome trials have repeatedly demonstrated:
There appears to be no harmful lower threshold for LDL cholesterol in high-risk ASCVD patients.
The concept is simple:
Less LDL cholesterol means less plaque accumulation.
Less plaque means lower risk of:
Heart attack
Stroke
Need for repeat stenting
Cardiovascular death
For patients who already have coronary stents, achieving LDL-C target is not optional—it is essential.
A Message for Patients with Previous Stents
Many patients ask:
“My stent is already inserted. Can I stop my cholesterol medication?”
The answer is no.
A stent treats one blockage.
ASCVD is a disease affecting the entire vascular system.
Without continued LDL control:
Existing plaques may enlarge
New plaques may develop
Future heart attacks can still occur
The goal is not just fixing today’s blockage.
The goal is preventing tomorrow’s heart attack.
The Future of Cholesterol Management
The landscape of cardiovascular prevention is rapidly evolving.
From statins to PCSK9 inhibitors and now siRNA technology, clinicians have more tools than ever before to help patients achieve guideline-directed LDL targets.
The future is shifting toward:
Earlier intervention
More intensive LDL reduction
Better adherence
Long-term cardiovascular protection
For patients living with ASCVD, the journey truly is a marathon.
And every reduction in LDL cholesterol is another step toward finishing that marathon stronger.
Key Takeaway
ASCVD is a lifelong disease.
LDL cholesterol remains the most important modifiable risk factor.
With innovative therapies such as Sybrava (siRNA), achieving and maintaining very low LDL-C levels may become easier, helping reduce the risk of future cardiovascular events.
Remember:
The stent fixes the blockage. Lowering LDL cholesterol protects your future.
The session, sponsored by AstraZeneca, highlighted a simple but important message:
The journey to saving a heart begins in the Emergency Department.
Every minute counts when a patient presents with chest pain. The decisions made during the first few hours can significantly influence survival, preservation of heart muscle, and long-term cardiovascular outcomes.
Why the Emergency Department Matters
The Emergency Department serves as the frontline in the battle against cardiovascular disease. For patients presenting with ACS, timely recognition and evidence-based treatment can mean the difference between recovery and devastating complications.
Key objectives discussed during the session included:
Rapid identification of ACS patients
Early ECG interpretation
Appropriate risk stratification
Prompt initiation of antiplatelet therapy
Early activation of reperfusion pathways for STEMI patients
Efficient referral and collaboration with the cardiology team
Recognising High-Risk ACS Patients
Emergency physicians frequently encounter patients with atypical symptoms. While classic crushing chest pain remains a hallmark presentation, clinicians must also maintain a high index of suspicion for:
Shortness of breath
Epigastric discomfort
Diaphoresis
Unexplained fatigue
Syncope
Atypical presentations in women, elderly patients, and diabetics
Early recognition remains the cornerstone of successful management.
The Importance of Early Dual Antiplatelet Therapy
One of the key discussions centred around platelet inhibition in ACS.
Platelet activation and thrombus formation are central mechanisms responsible for coronary artery occlusion. Early initiation of dual antiplatelet therapy (DAPT), when appropriate, helps reduce recurrent ischaemic events and stent thrombosis following coronary intervention.
The session reviewed current evidence and guideline recommendations regarding:
Aspirin administration
P2Y12 inhibitor selection
Timing of therapy initiation
Balancing ischaemic and bleeding risks
Particular attention was given to ensuring that treatment decisions are individualised according to patient characteristics and clinical presentation.
Time is Muscle
The concept of “Time is Muscle” remains as relevant today as ever.
For STEMI patients:
✅ Door-to-ECG within 10 minutes ✅ Rapid diagnosis ✅ Early activation of the catheterisation laboratory ✅ Minimising door-to-balloon time
Every delay results in greater myocardial injury and worse long-term outcomes.
Emergency physicians play a pivotal role in ensuring these patients reach definitive treatment as quickly as possible.
Beyond the Acute Event
Successful ACS management does not end after reperfusion.
We also discussed the importance of:
High-intensity lipid lowering therapy
Secondary prevention strategies
Lifestyle modification
Cardiac rehabilitation
Long-term medication adherence
For patients who undergo coronary stenting, maintaining optimal LDL-C levels and adherence to prescribed antiplatelet therapy remain critical components of preventing recurrent cardiovascular events.
A Collaborative Effort
Improving outcomes in ACS requires seamless teamwork between emergency physicians, nurses, cardiologists, catheterisation laboratory staff, and rehabilitation teams.
Together, we continue to strengthen our systems of care and ensure that every ACS patient receives the timely, evidence-based treatment they deserve.
Key Take-Home Message
❤️ Winning in every ACS patient starts in the Emergency Department.
Early recognition, rapid risk assessment, timely antiplatelet therapy, and prompt reperfusion remain the foundations of successful ACS care.
Thank you to the Emergency Department team at KPJ Johor Specialist Hospital for your dedication and commitment to delivering exceptional cardiovascular care.
Sejujurnya, kisah seperti ini bukan sekadar “kes berhasil”—ini adalah pengingat betapa tipisnya batas antara waktu dan nyawa. Kisah dari Batam.
Seorang pasien datang jauh dari Batam, menyeberangi laut dalam kondisi nyeri dada yang semakin memberat. Saat tiba, gejala yang dialaminya sangat khas untuk serangan jantung akut atau Infark Miokard Akut—suatu kondisi di mana aliran darah ke otot jantung terhenti secara tiba-tiba akibat sumbatan pembuluh darah koroner.
Dalam situasi seperti ini, waktu bukan lagi sekadar angka di jam. Setiap menit berarti jaringan jantung yang bisa diselamatkan—atau hilang selamanya.
Setelah penilaian awal dan konfirmasi diagnosis, kami segera membawa pasien ke cath lab untuk melakukan Angioplasti Koroner. Prosedur ini bertujuan membuka pembuluh darah yang tersumbat menggunakan balon kecil, diikuti dengan pemasangan Stent Koroner untuk memastikan aliran darah tetap lancar.
Prosesnya berjalan dengan fokus dan koordinasi tinggi. Dalam kondisi darurat seperti ini, setiap langkah harus cepat, tepat, dan terkoordinasi dengan baik. Tim cath lab, perawat, hingga dokter semuanya bergerak sebagai satu kesatuan.
Syukurlah, pembuluh darah yang tersumbat berhasil dibuka, dan aliran darah ke jantung kembali normal.
Namun, yang paling berkesan bukan hanya keberhasilan prosedurnya.
Hari berikutnya, saat melakukan review di wad, kami melihat pasien sudah bisa duduk, berbicara, dan—yang paling penting—tersenyum bersama keluarganya. Wajah yang sebelumnya penuh kecemasan kini berubah menjadi lega dan penuh harapan.
Perjalanan dari Batam bukanlah hal yang mudah, apalagi dalam kondisi darurat. Tapi keputusan untuk segera mencari pertolongan medis terbukti menyelamatkan nyawanya.
Kisah ini kembali menegaskan satu hal penting: jangan pernah menunda saat muncul gejala serangan jantung.
Nyeri dada, rasa tertekan di dada, menjalar ke lengan atau rahang, sesak napas, atau keringat dingin—semuanya adalah tanda bahaya yang tidak boleh diabaikan. Semakin cepat tindakan dilakukan, semakin besar peluang untuk menyelamatkan otot jantung dan kualitas hidup pasien ke depannya.
Bagi kami sebagai dokter, momen melihat pasien pulih dan kembali ke keluarganya adalah kepuasan yang tidak bisa diukur dengan apapun.
Karena pada akhirnya, ini bukan hanya tentang prosedur atau teknologi. Ini tentang manusia, tentang keluarga, dan tentang kesempatan kedua dalam hidup.
My recent trip to ACC Asia 2026 in the historic city of Gyeongju was both professionally enriching and personally memorable. Known as “the museum without walls,” Gyeongju provided the perfect backdrop for a gathering of cardiology minds across the region.
A Proud Professional Milestone
One of the most significant highlights of this trip was being conferred the Fellow of the American College of Cardiology (FACC) during the convocation ceremony. Receiving this recognition from the American College of Cardiology is a meaningful milestone in my journey as a cardiologist. It represents not just years of clinical practice, but also a continued commitment to advancing cardiovascular care and improving patient outcomes.
Standing among respected peers and mentors, the moment was both humbling and motivating—a reminder of the responsibility we carry in shaping the future of cardiology.
Exploring the Timeless Beauty of Gyeongju
Beyond the conference halls, I had the opportunity to explore some of Korea’s most iconic historical landmarks:
The serene Bulguksa Temple, a UNESCO World Heritage site, offered a glimpse into Korea’s rich Buddhist heritage and architectural brilliance.
The ancient Cheomseongdae Observatory, one of the oldest surviving observatories in Asia, stood as a testament to early scientific advancement.
The Daereungwon Tomb Complex, with its rolling burial mounds, reflected the grandeur of the Silla dynasty.
Walking through these sites felt like stepping back in time—an inspiring contrast to the modern innovations discussed during the conference.
A Vibrant Stop in Busan
The journey continued to Busan, South Korea’s dynamic coastal city, where culture meets scenic beauty:
The colorful hillside houses of Gamcheon Culture Village created a lively and artistic atmosphere.
A ride on the Songdo Marine Cable Car offered breathtaking panoramic views of the coastline.
And of course, the iconic Haeundae Beach provided a perfect moment of relaxation by the sea.
Reflections
This trip was more than just a conference—it was a journey of growth, recognition, and cultural appreciation. From meaningful academic exchanges at ACC Asia 2026 to the honor of receiving FACC, and the unforgettable experiences across Gyeongju and Busan, every moment added depth to both my professional and personal journey.
Grateful for the experience, and looking forward to continuing this path of learning, service, and excellence in cardiology.
Grateful for the experience for Singapore Airlines Business class!!
On 21st April 2026, I had the privilege of speaking at the Sandoz JB GP Forum held at Novotel Johor Bahru City Centre. The event brought together general practitioners and healthcare professionals from across Johor for an evening of practical, case-based discussions aimed at improving primary care management.
My Session: Cholesterol Control in Real-World Practice
My talk, titled:
“Are You in Control of Your Cholesterol? Goals & Management of Hyperdyslipidemia”
focused on one of the most critical yet often underestimated cardiovascular risk factors — cholesterol.
We explored:
The importance of early detection and risk stratification
Updated LDL-C targets based on cardiovascular risk
Common gaps in achieving lipid goals in daily practice
Practical strategies to optimize treatment, including when to intensify therapy
The role of patient adherence and long-term follow-up
One key takeaway is simple but powerful: 👉 Many patients are treated, but not treated to target.
Bridging the Gap in Primary Care
Primary care plays a central role in preventing heart attacks and strokes. However, despite clear guidelines, a significant number of patients remain above their recommended LDL levels.
During the session, we discussed:
When lifestyle measures are not enough
When to escalate therapy beyond statins
How to individualize treatment without overcomplicating care
The goal is not just prescribing medication — but achieving outcomes.
Engaging Discussions & Collaboration
The session was followed by an interactive Q&A, where we had insightful discussions on real-world challenges faced by GPs — from patient compliance to medication accessibility.
It was encouraging to see such active participation and shared commitment toward improving cardiovascular care in the community.
Gratitude
I would like to thank Sandoz Malaysia for organizing this meaningful forum, and all the attendees for their engagement and thoughtful questions.
Final Thought
Cardiovascular disease remains the leading cause of death, but it is also one of the most preventable.
