Phan Vichet, MD

18/08/2025

Did you know chances are higher you’ll live longer if you have type O blood? Experts think your lowered risk of disease in your heart and blood vessels may be one reason for this. https://wb.md/46Q0FNH

18/08/2025

High Blood Pressure

17/08/2025

ABCDE to identify and prevent chronic kidney disease: a call to action

The ABCDE approach is centred around information on risk factors that can be generated by the healthcare system only by answering five questions for any individual:
A- What is my Albuminuria (albumin in urine)?
B- What is my Blood pressure?
C- What is my Cholesterol?
D- Am I Diabetic?
E- What is my kidney function (Estimated GFR)?

17/08/2025

Treatment strategies to reduce cardiovascular risk and chronic kidney disease in Type 2 diabetes

17/08/2025

Optimal Prescribing of Statins to Reduce
Cardiovascular Disease

• Cardiovascular Disease (CVD) Context: CVD is the leading cause of death globally and in the US, largely preventable through lifestyle changes and cholesterol-lowering medications like statins. Statins inhibit HMG-CoA reductase, the key enzyme in cholesterol synthesis, but are often prescribed incorrectly, leading to high adverse events, poor patient compliance (50% discontinue within a year), and failure to meet LDL cholesterol goals in over half of at-risk patients.
• Adverse Effects of Statins: Only two confirmed in randomized trials—myalgias (muscle pain) and glucose intolerance (increased diabetes risk). These are dose-dependent and related to blood statin levels. Myalgias are often not reproducible in blinded studies, and rhabdomyolysis is rare but occurs at high concentrations. Strategy: Use the lowest effective dose to minimize risks while achieving LDL targets.
• Metabolic Effects and Optimization: Statins reduce hepatic cholesterol, increasing LDL receptors to clear circulating LDL. However, they also upregulate genes that boost intestinal cholesterol absorption and hepatic reuptake from bile via the Niemann-Pick C1-Like 1 receptor. To counter this, combine statins with ezetimibe (10 mg/d), which blocks this receptor, adding ~18% LDL reduction without extra adverse effects.
• Recommended Statin: Rosuvastatin: Preferred due to high potency (10 mg/d reduces LDL by ~40%, equivalent to 40 mg atorvastatin), minimal drug-drug interactions (90% excreted unchanged via bile, avoiding cytochrome P4503A4 competition), and no diabetes risk at 10 mg/d. It outperforms atorvastatin, simvastatin, and pravastatin in LDL reduction across doses. All statins are generic and cost-effective.
• Anti-Inflammatory Benefits: Statins reduce inflammation (measured by C-reactive protein levels), aiding in acute coronary syndromes. Rosuvastatin shows rapid onset and superior effects (e.g., 20 mg/d better than 40 mg atorvastatin), further enhanced by ezetimibe.
• Overall Recommendation: For most at-risk patients, start with 10 mg rosuvastatin + 10 mg ezetimibe daily to balance LDL lowering (~40-58%), anti-inflammatory effects, and minimal adverse events (dose-related). This combo is superior to higher-dose rosuvastatin monotherapy in efficacy and safety, per recent trials.
• Figure Summary: Illustrates that statin adverse effects increase with dose, while LDL-lowering potency per mg decreases at higher doses; 10 mg rosuvastatin strikes a balance, amplified by ezetimibe.
The commentary emphasizes physiology-based prescribing to improve outcomes and compliance, with references to studies supporting these points.

https://www.amjmed.com/action/showPdf?pii=S0002-9343%2823%2900496-5

17/08/2025

Treatment strategies to reduce cardiovascular risk in
persons with chronic kidney disease and Type 2
diabetes

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/joim.20050?

16/08/2025

Immediate coronary angiography does not improve 1-year survival compared to delayed or selective strategies in patients with out-of-hospital cardiac arrest without ST-segment elevations. https://ja.ma/3V3FU9S

16/08/2025

Summary of the 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

This guideline, developed by a multidisciplinary writing committee and endorsed by multiple organizations, updates the 2017 version. It focuses on preventing, detecting, evaluating, and managing high blood pressure (BP) in adults, emphasizing evidence-based strategies to reduce cardiovascular disease (CVD) risk. It is a “living document” for primary care and specialty clinicians, based on literature from February 2015 onward. Key themes include risk-based treatment, lifestyle interventions, multidisciplinary care, and addressing disparities. Below is a structured summary of the main points, drawn from the abstract, “What Is New” table, top take-home messages, table of contents, and key recommendations in the provided excerpt.

1. Key Updates and “What Is New” (Practice-Changing Recommendations)
• New Terminology: “Hypertensive urgency” is replaced with “severe hypertension” (BP >180/120 mm Hg without acute target organ damage).
• Screening for Secondary Hypertension: Screen for primary aldosteronism in resistant hypertension (regardless of hypokalemia) using continued antihypertensive meds (except mineralocorticoid receptor antagonists [MRAs]).
• Lifestyle: Potassium-based salt substitutes are useful for BP control, especially in home cooking, but monitor in CKD or with potassium-sparing drugs.
• BP Thresholds for Treatment:
◦ Initiate meds at SBP ≥130 mm Hg or DBP ≥80 mm Hg in adults without clinical CVD but with diabetes, CKD, or 10-year CVD risk ≥7.5% (using PREVENT equations).
◦ For lower-risk adults (

The 🆕 AHA/ACC/Multisociety on high blood pressure provides updated recommendations for clinicians on the prevention, detection, evaluation, and management of high blood pressure in adults.

Published in , the new guideline reflects the latest research and evidence since February 2015 and replaces the previous version from 2017. The guideline includes new recommendations addressing topics like secondary forms of hypertension, primary aldosteronism, lifestyle and psychosocial approaches, hypertension and pregnancy, acute intracerebral hemorrhage, resistant hypertension and renal denervation, diabetes, chronic kidney disease and mild cognitive impairment and dementia.

Access the guideline here ➡️ https://bit.ly/4oCwJLk

16/08/2025

Does alcohol increase pancreatic cancer risk?

09/08/2025

The antiseizure medication pregabalin, which is commonly prescribed for chronic pain, has been linked to an increased risk for heart failure (HF), particularly in those with a history of cardiovascular disease (CVD), new data suggested. http://ms.spr.ly/6185s3QrT

09/08/2025

អ្វីទៅជាជំងឺហឺត

ជំងឺហឺត ឬហៅថា (Asthma) ជាជំងឺរលាកទងសួតរ៉ាំរ៉ៃទាក់ទងទៅនឹងកត្តាអាល្លែកហ្ស៊ីដូចជា ផ្សែង ធូលី ចំណីអាហារ លំអងផ្កា រោមសត្វ អាកាសធាតុត្រជាក់ និងកត្តាផ្សេង ៗ ទៀត។ ជំងឺហឺតកើតទៅលើមនុស្សគ្រប់វ័យពិសេស វ័យកុមារ ឬអ្នកដែលមានប្រវត្តិគ្រួសារធ្លាប់មាន
ជំងឺហឺត។ ជំងឺហឺត ជាប្រភេទជំងឺមិនឆ្លង យើងអាចព្យាបាលនឹងគ្រប់គ្រងជំងឺនេះបាន។

រោគសញ្ញាជំងឺហឺត
• អ្នកជំងឺមានអការៈក្អកស្លេស និងផ្តាសាយញឹកញាប់
• ពិបាកដកដង្ហើម តឹងណែនទ្រូង ថប់ដង្ហើម ឡេះឡះ
• ពេលធ្វើទុក្ខខ្លះ អ្នកជំងឺដកដង្ហើម លឺសូរសំលេង ងឺតៗ សំលេង
ដូចឆ្មារ ឬ យើងហៅថាសំលេងហួច
• អ្នកជំងឺច្រើនតែពិបាកដកដង្ហើម នៅពេលយប់ជ្រៅ ជាពិសេស
ក្រោយពេលប៉ះជាមួយកត្តាអាល្លែកហ្ស៊ីដែលអ្នកជំងឺធ្លាប់មានពីមុនមក។

ការព្យាបាលជំងឺហឺត
ប្រសិនលោកអ្នកមានរោគសញ្ញាខាងលើ សង្ស័យថាខ្លួនកើតជំងឺហឺតសូមបងប្អូនមកពិគ្រោះជាមួយវេជ្ជៈបណ្ឌិតឯកទេសផ្លូវដង្ហើម នៅមន្ទីរពេទ្យជោរៃ ភ្នំពេញដើម្បីធ្វើរោគវិនិច្ឆ័យបានត្រឹមត្រូវព្រោះការព្យាបាលជំងឺហឺតត្រូវមានការសហការរវាងគ្រូពេទ្យ និងអ្នកជំងឺដោយផ្ទាល់ទើបការព្យាបាលជំងឺហឺតបានទទួលជោគជ័យ ។

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05/08/2025

Dapagliflozin-spironolactone reduces NT-proBNP levels and blood pressure more than dapagliflozin alone but at the cost of a greater decline in kidney function and higher potassium levels, a new study finds: http://ms.spr.ly/6188szsCq