Nicholas Chew

Nicholas Chew
National University Heart Centre Singapore · Department of Cardiology

MBChB MMED MRCP (UK)
Areas of interest - Cardio-metabolic in acute coronary syndrome and valvular heart disease. Looking to collaborate.

About

291
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Publications

Publications (291)
Article
Full-text available
Background Emerging evidence has demonstrated the unfavourable cardiovascular risk of individuals with lean type 2 diabetes mellitus (T2DM). Our study aims to investigate the prognostic value of lean T2DM in patients with acute myocardial infarction (AMI), stratified by sex. Methods The study cohort examines the clinical characteristics and long-t...
Article
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Background Postprandial glucose concentration 1-h (1 h-PG) after an oral glucose tolerance test (OGTT) has similar or superior performance to 2 h-PG in predicting type-2 diabetes mellitus (T2DM) in several populations, and is simpler to obtain in clinical practice. However, studies in Asians are scarce. We investigated the utility of elevated basel...
Article
There is a new awareness of the widespread nature of metabolic dysfunction–associated steatotic liver disease (MASLD) and its connection to cardiovascular disease (CVD). This has catalyzed collaboration between cardiologists, hepatologists, endocrinologists, and the wider multidisciplinary team to address the need for earlier identification of thos...
Article
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Purpose Coronary CT angiography (CCTA) is well established for the diagnostic evaluation and prognostication of coronary artery disease (CAD). The growing burden of CAD in Asia and the emergence of novel CT-based risk markers highlight the need for an automated platform that integrates patient data with CCTA findings to provide tailored, accurate c...
Article
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BACKGROUND Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease. The relationship between Lp(a) and major adverse cardiovascular events (MACE) in the context of high-sensitivity C-reactive protein (hs-CRP) levels remains controversial due to conflicting results from previous studies. OBJECTIVES This syste...
Article
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Purpose This meta-analysis investigates the sex differences in mortality risk between the acute coronary syndrome (ACS) population without standard modifiable risk factors (SMuRF-less) and those with at least one standard modifiable risk factor (SMuRF), and analyses mortality rates between males and females within the SMuRF-less cohort. Methods Th...
Article
Introduction: Both Lipoprotein(a) [Lp(a)] and Hemoglobin A1c (HbA1c) are established independent predictors of major adverse cardiovascular events (MACE). Evidence suggests there is an inverse association between Lp(a) concentration and risk of T2DM. While prior studies have evaluated the effect of Lp(a) on DM incidence, the association of Lp(a) wi...
Article
Objective Metabolic dysfunction‐associated steatotic liver disease (MASLD) and obesity increases risk of cardiovascular disease. This cohort study examines the prognostic value of MASLD, across body weight categories, in a secondary preventative acute myocardial infarction (AMI) cohort. Methods Patients with AMI were stratified into four phenotype...
Article
Background and Purpose Major adverse cardiovascular event (MACE) is one of the most used composite outcomes in coronary artery disease (CAD) trials, though its lack of a standardised definition has led to ambiguity and challenges in its interpretation. This study aims to elucidate the definition of MACE and guide future interpretation of MACE in th...
Article
Background Metabolic dysfunction-associated liver disease (MASLD) and chronic kidney disease (CKD) are both diseases that can cause increased cardiovascular risk. Recent studies have revealed that the combination of both is a more potent risk factor for ischemic heart disease. However, the mortality and outcomes of patients presenting with acute my...
Article
Background With differences in prevalence, risk profile, cardiovascular complications, and mortality of patients with acute coronary syndrome (ACS) in the absence of standard modifiable risk factors (SMuRF-less) worldwide, this study examines the regional differences and the unique risk profiles of this often-understudied group of patients. Purpos...
Article
Background Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are at increased risk of incident cardiovascular disease. However, the clinical characteristics and prognostic importance of MASLD in patients presenting with acute myocardial infarction (AMI) have yet to be examined. Methods This study compared the character...
Conference Paper
Background Limited data exists on mortality outcomes of aortic stenosis (AS) in Southeast Asians. Insights into this may confer prognostic benefits and affect therapeutic targets. Purpose Our study aims to provide insights into 10-year mortality outcomes and prognostic indicators of AS in this cohort. Methods Consecutive patients (n = 703) with e...
Article
Objective Cardiometabolic outcomes are intrinsically linked with obesity. According to a study by Jayedi A et al. a 5kg weight gain could increase CVD mortality and MI risk by 11% and 18% respectively, with most overweight and obese patient also suffering from cardiometabolic derangements. This network meta-analysis evaluates cardiometabolic effect...
Article
Background Cardiovascular diseases (CVDs) are the primary cause of global mortality and morbidity. Controlling modifiable risk factors driving the CVD epidemic is a vital focus of primary prevention efforts worldwide. Understanding the epidemiological trends in these risk factors is therefore essential in designing effective countermeasures against...
Article
Background Patients with obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) have an increased risk of cardiovascular disease. This study seeks to examine the prognostic significance of obesity and MASLD in patients presenting with acute myocardial infarction (AMI). Methods This study compared the clinical characteristics...
Article
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Aims The prediction of future trends in cardiovascular disease (CVD) mortality and their risk factors can assist policy-makers in healthcare planning. This study aims to project geospatial trends in CVDs and their underlying risk factors from 2025 to 2050. Methods and results Using historical data on mortality and disability-adjusted life years (D...
Article
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The ‘rule-of-6’ prediction tool was shown to be able to identify COVID-19 patients at risk of adverse outcomes. During the pandemic, we frequently observed hyponatremia at presentation. We sought to evaluate if adding hyponatremia at presentation could improve the ‘rule-of-6’ prediction tool. We retrospectively analysed 1781 consecutive patients ad...
Article
Background A growing population of patients with chronic kidney disease (CKD) presents with non–ST‐segment–elevation myocardial infarction, although little is known about their longer‐term mortality. Methods and Results Using the MINAP (Myocardial Ischaemia National Audit Project) registry, linked to Office for National Statistics mortality data,...
Article
Introduction Takotsubo cardiomyopathy (TTC) is a cardiovascular disease caused by physical/psychological stressors with significant morbidity if left untreated. Because TTC often mimics acute myocardial infarction in the absence of obstructive coronary disease, the condition is often underdiagnosed in the population. Our aim was to discuss the role...
Article
Introduction Early in the coronavirus disease 2019 (COVID-19) pandemic, a low incidence of cardiovascular complications was reported in Singapore. Little was known about the trend of cardiovascular complications as the pandemic progressed. In this study, we examined the evolving trends in electrocardiographic and cardiovascular manifestations in pa...
Article
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Background: Given the rapidly growing burden of cardiovascular disease (CVD) in Asia, this study forecasts the CVD burden and associated risk factors in Asia from 2025 to 2050. Methods: Data from the Global Burden of Disease 2019 study was used to construct regression models predicting prevalence, mortality, and disability-adjusted life years (DALY...
Article
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Food‐derived extracellular vesicles (FEVs) are nanoscale membrane vesicles obtained from dietary materials such as breast milk, plants and probiotics. Distinct from other EVs, FEVs can survive the harsh degrading conditions in the gastrointestinal tract and reach the intestines. This unique feature allows FEVs to be promising prebiotics in health a...
Article
Aim Patients with metabolic dysfunction‐associated steatotic liver disease (MASLD) are at increased risk of incident cardiovascular disease. However, the clinical characteristics and prognostic importance of MASLD in patients presenting with acute myocardial infarction (AMI) have yet to be examined. Methods This study compared the characteristics...
Article
Full-text available
Objectives: To evaluate the impact of bariatric surgery on the pharmacokinetic (PK) parameters of orally administered medications and supplements. Methods: Systematic searches of bibliographic databases were conducted to identify studies. Pooled effect estimates from different surgical procedures were calculated using a random-effects model. Re...
Poster
P0388 Background Several clinical risk scores have been developed to identify patients at risk of deterioration from coronavirus disease 2019 (COVID-19) to guide patient triage and clinical management. In 2020, when alpha variant was dominant, the ‘rule-of-6’ prediction tool (C-reactive protein, CRP>60 mg/L, lactate dehydrogenase, LDH>600 U/L and f...
Article
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Background During the covid-19 pandemic there was a marked rise in the number of cardiovascular deaths. Obesity is a well-known modifiable risk factor for cardiovascular disease and has been identified as a factor which leads to poorer covid-19 related outcomes. In this study we aimed to analyse the impact of covid-19 on obesity-related cardiovascu...
Article
Objective This network meta‐analysis evaluates the efficacy and safety of tirzepatide compared to glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA) and other weight loss drugs in the treatment of overweight and obesity. Methods MEDLINE, Embase, and Cochrane CENTRAL were searched for randomized controlled trials on tirzepatide, GLP‐1 RA, and wei...
Article
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Purpose of Review The objective of this manuscript is to examine the current literature on the epidemiology of metabolic dysfunction-associated steatotic liver disease (MASLD), its correlation with cardiovascular disease (CVD) outcomes, as well as to evaluate the update in nomenclature from non-alcoholic liver disease (NAFLD). Recent Findings The...
Article
Introduction Patients with paradoxical low-flow (LF) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction (LVEF) appear distinct from normal-flow (NF) patients, showing worse prognosis, more concentric hypertrophy and smaller left ventricular (LV) cavities. The left ventricular remodelling index (LVRI) has been demonstra...
Article
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Introduction With in increase in interest to incorporate artificial intelligence (AI) into weight management programs, we aimed to examine user perceptions of AI-based mobile apps for weight management in adults with overweight and obesity. Methods 280 participants were recruited between May and November 2022. Participants completed a questionnair...
Article
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Context Polyphenols are plant-based compounds with potential anti-inflammatory, antioxidant, and anti-obesogenic properties. However, their effects on health outcomes remain unclear. Objective To evaluate the effects of polyphenols on anthropometric and cardiometabolic markers. Data Sources Six electronic databases—namely, EMBASE, CINAHL, PubMed,...
Article
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Obesity, a chronic low-grade inflammatory disease represented by multifactorial metabolic dysfunctions, is a significant global health threat for adults and children. The once-held belief that type 1 diabetes is a disease of people who are lean no longer holds. The mounting epidemiological data now establishes the connection between type 1 diabetes...
Article
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Background Literature suggests a bidirectional association between advanced hepatic fibrosis (AHF) and coronary artery disease (CAD). We evaluated the association of AHF with immune activation, systemic inflammation, and adverse outcomes in patients with CAD. Methods and Results A fibrosis‐4 index cutoff value ≥2.67 was used to define AHF. Circula...
Article
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Background Temporal trends of the impact of social determinants on cardiovascular outcomes of cancer patients has not been previously studied. Objectives This study examined social disparities in cardiovascular mortality of people with and without cancer in the US population between 1999 and 2019. Methods Primary cardiovascular deaths were identi...
Article
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Background Although individuals with cancer experience high rates of cardiovascular morbidity, there are limited data on the potential differences in cardiovascular health (CVH) metrics between individuals with and without cancer. Methods and Results The National Health and Nutrition Examination Survey between 2015 and 2020 was queried to evaluate...
Article
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Background Sex differences in clinical presentation and outcomes in patients with coronavirus disease 2019 (COVID-19) remain to be clearly defined. We sought to evaluate sex differences in the presentation and outcomes of COVID-19 in our Asian context. Methods We retrospectively examined 1781 consecutive patients hospitalised from 2020 to 2021, wi...
Article
Full-text available
Through extensive multisystem phenotyping, the central aim of Project PICMAN is to correlate metabolic flexibility to measures of cardiometabolic health, including myocardial diastolic dysfunction, coronary and cerebral atherosclerosis, body fat distribution and severity of non-alcoholic fatty liver disease. This cohort will form the basis of large...
Article
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Purpose of Review The objective of this manuscript is to examine the current literature on non-alcoholic fatty liver disease (NAFLD) biomarkers and their correlation with cardiovascular disease (CVD) outcomes and cardiovascular risk scores. Recent Findings There has been a growing appreciation for an independent link between NAFLD and CVD, culmina...
Article
Introduction: Nonalcoholic fatty liver disease (NAFLD) affects 1 in 3 Americans and is associated with an increased cardiovascular disease (CVD) risk, however the association of cardiovascular health (CVH), quantified by the AHA Life’s Essential 8 (LE8) score, and NAFLD is unclear. Hypothesis: CVH has an inverse association with NAFLD quantified us...
Article
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BACKGROUND There is emerging evidence that malnutrition is associated with poor prognosis among patients with acute coronary syndrome (ACS). OBJECTIVES This study seeks to elucidate the prognostic impact of malnutrition in patients with ACS and provide a quantitative review of most commonly used nutritional assessment tools. METHODS Medline and E...
Article
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Abstract Reducing the incidence and prevalence of standard modifiable cardiovascular risk factors (SMuRFs) is critical to tackling the global burden of coronary artery disease (CAD). However, a substantial number of individuals develop coronary atherosclerosis despite no SMuRFs. SMuRFless patients presenting with myocardial infarction have been obs...
Article
Background: The characteristics and risk factor profile of young patients presenting with non-ST segment elevation acute coronary syndrome (NSTEACS) and how they may have changed over time is not well reported. Methods: We identified 26,708 NSTEACS patients aged under 50 presenting to United Kingdom (UK) hospitals between 2010 and 2017 from Myoc...
Article
Atherosclerosis is a chronic inflammatory vascular disease that is characterized by the accumulation of lipids and immune cells in plaques built up inside artery walls. Docosahexaenoic acid (DHA, 22:6n-3), an omega-3 polyunsaturated fatty acid (PUFA), which exerts anti-inflammatory and antioxidant properties, has long been purported to be of therap...
Article
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Background In the past few decades, diabetes‐related cardiovascular mortality has been steadily declining. However, the impact of the COVID19 pandemic on this trend has not been previously defined. Methods and Results Diabetes‐related cardiovascular mortality data were extracted for each year between 1999 and 2020 from the Centers for Disease Cont...
Conference Paper
Background Non-alcoholic fatty liver disease (NAFLD) has risen significantly in global incidence and is widely considered a multisystem disease linked to numerous extrahepatic manifestations. We aim to investigate the associated longitudinal outcomes of NAFLD. Methods We performed a systematic review and meta-analysis of observational studies asse...
Article
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Objectives: In critically ill patients with COVID-19, distinct hyperinflammatory and hypoinflammatory phenotypes have been described, with different outcomes and responses to therapy. We investigated if similar phenotypes exist in non-severe illness. Methods: Consecutive patients with polymerase chain reaction (PCR) confirmed SARS-CoV-2 were exa...
Article
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Background: Understanding the trajectories of metabolic risk factors for acute myocardial infarction (AMI) is necessary for healthcare policymaking. We estimated future projections of the incidence of metabolic diseases in a multi-ethnic population with AMI. Methods: The incidence and mortality contributed by metabolic risk factors in the populati...
Article
Background: Recent studies suggest that tirzepatide, a dual glucose-dependent insulinotropic-peptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1 RA), has significant weight loss effects. This systematic review and meta-analysis aims to assess the efficacy and safety of tirzepatide for weight loss in patients with overweight or obesit...
Article
Full-text available
We conducted an umbrella review to consolidate the evidence of adopting plant-based diets on anthropometric and cardiometabolic outcomes. Six electronic databases (CINAHL, EMBASE, PubMed, Scopus, the Cochrane Library, and Web of Science) were searched for systematic reviews with meta-analysis (SRMAs) published from each journal's inception until 1...
Article
Background: Epicardial adipose tissue (EAT) has garnered attention as a prognostic and risk stratification factor for cardiovascular disease. This study, via meta-analyses, evaluates the associations between EAT and cardiovascular outcomes stratified across imaging modalities, ethnic groups, and study protocols. Methods: Medline and Embase datab...
Article
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Foundation Background Characterizing enzyme secretion with surface antigen expression of circulating leukocytes provides deep immunological insights that may benefit diagnostics and therapeutics of acute myocardial in...
Article
Background: Low socioeconomic status (SES) is an important prognosticator amongst patients with acute coronary syndrome (ACS). This paper analysed the effects of SES on ACS outcomes. Methods: Medline and Embase were searched for articles reporting outcomes of ACS patients stratified by SES using a multidimensional index, comprising at least 2 of...
Article
Background Previous studies have shown that females with type 2 diabetes mellitus (T2DM) may have excess mortality risk compared to their male counterparts. An important next step to address the high global burden of T2DM and cardiovascular disease (CVD) is an umbrella review to summarize data on sex differences in cardiovascular outcomes for patie...
Article
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Background Health literacy and illness perception play crucial roles in tackling the cardiometabolic disease epidemic. We aim to compare the attitudes, knowledge, self-perceived risks and actions taken, between individuals with and without metabolic risk factors (MFs). Methods From 5 June to 5 October 2022, participants of the general public were...
Article
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While various influencing factors of overweight and obesity have been identified, the underlying mechanism remains unclear. We examined the relationships among sociodemographic, behavioral, and psychological factors on anthropometry in a multi-ethnic population with overweight and obesity. Participants (N = 251) were recruited from January to Octob...
Article
Although most of the current evidence on myocardial infarction focuses on obesity, there is growing evidence that patients who are underweight have unfavorable prognosis. This study aimed to explore the prevalence, clinical characteristics, and prognosis of this population at risk. Embase and Medline were searched for studies reporting outcomes in...
Chapter
Chronic liver diseases are a source of morbidity and mortality worldwide with huge implications on public health. Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease, mirroring the rising rates of metabolic syndrome worldwide. NAFLD results from the accumulation of fat in the liver, in the absence of alcohol c...
Article
Introduction: Management of aortic stenosis (AS) in patients with chronic kidney disease (CKD) may often be overlooked, and this could confer poorer outcomes. Methods: Consecutive patients (n = 727) with index echocardiographic diagnosis of moderate to severe AS (aortic valve area <1.5 cm2) were examined. They were divided into those with CKD (e...
Article
Background: The double burden of malnutrition, described as the coexistence of malnutrition and obesity, is a growing global health issue. This study examines the combined effects of obesity and malnutrition on patients with acute myocardial infarction (AMI). Methods: Patients presenting with AMI to a percutaneous coronary intervention-capable h...