Lives of the fellows

Kah Lin Khoo

b.18 December 1938 d.7 November 2014
MB BS Singapore(1963) MRCP(1970) MRCPI(1970) FRCPI(1982) MD(1983) FRCP Glasg(1984) FAMM(1998) FACC(2002) FRCP Edin(2004) FRCP(2006)

Kah Lin Khoo was an eminent cardiologist and lipidologist in Malaysia. His passionate interest in lipid disorders led to a lifelong journey of case finding and research, which, with the assistance of John Kastelein and J C Defesche from the University of Amsterdam, uncovered a great variety of genetic lipid abnormalities in Malaysia. The main findings of his work are summarised in his book My cholesterol journey in Malaysia (VersaComm Sdn Bhd, Petaling Jaya, Selgonor, Malaysia, 2014) and in various journal publications. As an active member of the worldwide vascular research network, he collaborated closely with leading international centres and renowned lipidologists for better management of patients with lipid disorders.

Kah Lin Khoo was born in Penang, Malaysia, the son of Teng Keat Khoo, a merchant, and Lye Kheng Yu, a housewife. He was educated at St Xavier’s Institution. As a child he was rather sickly, with frequent respiratory infections. He was greatly inspired by a kindly European doctor, Dr Gunsteinsen from the George Town Dispensary, who used to cycle to his house to treat him, often without payment as the family could not always afford it.

Encouraged by his mother, he studied medicine at the University of Singapore and, upon graduation, he worked as a junior physician in various government hospitals in Malaysia. His diligence and enthusiasm at work impressed his superiors and he was granted a government scholarship to London to study for his membership examination of the Royal College of Physicians and to undergo training in cardiology under Lawson McDonald [Munk’s Roll, Vol.XII, web] and Richard Emanuel [Munk’s Roll, Vol.XII, web] at the London Hospital and Middlesex Hospital, as well as Frank Pantridge [Munk’s Roll, Vol.XII, web] in Belfast, noted for his work on mobile coronary care.

On his return to Malaysia, he set up the first coronary care unit at the General Hospital in Kuala Lumpur. His interest in familial hypercholesterolaemia (FH) was sparked by the admission of a 10-year-old boy with myocardial infarction. He had the classical signs of severe homozygous FH. Realising how simple it was to detect such cases clinically and how vital it was to have early preventive treatment, he embarked on an awareness campaign to identify cases of FH. With great enthusiasm, he taught everyone around him, including doctors, medical students, nurses and paramedics to recognise the classical signs of FH. House officers had to scour the wards looking out for such cases. He also approached dermatologists, fellow cardiologists and paediatricians to assist in case finding. As a result, numerous cases were found, their family genealogy painstakingly mapped out to trace family members. His studies took him to all corners of Malaysia, from cities to far-flung villages and islands, and even onto the shores of Indonesia in Medan, often assisted by his wife, a physician. His work was driven by sheer passion and dedication, being self-funded, without any research grants.

His work attracted the interest of academics in Singapore and Seah Cheng Siang from the National University of Singapore invited him to deliver a lecture on familial hypercholesterolaemia in Malaysia. He was encouraged to write a doctoral thesis, which he completed in 1983, entitled ‘A study of certain lipid abnormalities in peninsular Malaysia’, based on the study of 117 families who had FH, some of whom comprised of extended families, with as many as 183 members in the largest family.

He subsequently produced numerous publications, published in national and international journals. He became a fellow of the Royal Colleges of Physicians of London, Edinburgh, Glasgow and Ireland. He was a fellow of the American College of Cardiology, of the European Society of Cardiology and the Academies of Medicine of Malaysia, Singapore and the Asean region.

He was an outspoken representative on behalf of his patients and often gave freely of his time and money in his quest for improved awareness and treatment. To assist FH patients obtain their lifelong statin medication at affordable rates, he started the Inherited Cholesterol Disorder Club under the auspices of the Heart Foundation of Malaysia in collaboration with Merck Sharp and Dohme Pharmaceuticals. For the ‘untreatable’ homozygous FH patients resistant to drug therapy, a HELP (heparin induced extracorporeal low density lipoprotein precipitation) programme for cholesterol dialysis (low-density lipoprotein [LDL] apheresis) was set up with the assistance of charities and philanthropists under the Heart Foundation of Malaysia in collaboration with the Sau Seng Lum Charity Foundation and the University of Malaya Medical Centre, nephrology department. This is the only one in South East Asia, largely because it is nonprofit making.

To aid in fundraising, he embarked on an aggressive awareness campaign highlighting the dangers of FH and the importance of early treatment. He conducted public forums, television and press interviews, and produced educational pamphlets, newspaper articles and DVD materials for both public and medical personnel. He approached numerous corporations and individuals for financial aid to ‘adopt a patient’ for a year to sponsor their dialysis. The national airline also assisted in providing free air travel for patients from distant towns to fly to the dialysis centre for treatment.

Although he was not attached to an academic institution, his love of teaching saw him involved in frequent seminars, lectures and workshops in cardiology and lipidology. In recognition of his tremendous contributions to the medical and general community, he received a gold medal from the Rotary Club of Malaysia and a gold medal award, as well as an outstanding services award, from the Malaysian Medical Association.

He was master of the Academy of Medicine, president of the Malaysian Medical Association, of the National Heart Association of Malaysia and the Private Medical Practitioners Association, and director of the Heart Foundation of Malaysia. In 2003, he was honoured with a DIMP award by the Sultan of Pahang, which carries the tile of ‘dato’ (equivalent to a knighthood).

His hobbies included kung fu and tai chi on weekends, and karaoke singing whenever time permitted. Quality family time was spent travelling to places far and near, but his greatest love was medicine. Though medicine has its limitation, he practised it with dedication and compassion, following Hippocrates’ philosophy ‘Cure sometimes, treat often, comfort always’.

Up to the year of his death, he was working with Gerald Watts from Australia on the Malaysian segment of the Ten Countries Study, a programme of research aimed at improving the care of FH, funded by the International Atherosclerosis Society, of which he was an active member.

He was always immensely grateful to have had the support of so many colleagues and friends who shared his passion during his cholesterol journey. As he said: ‘I feel my life has been blessed; throughout my life I have often met people who have gone out of their way to help me, and, whenever I can, I try to do the same.’ At the launch of his book, he declared ‘I feel so blessed that the dreams I dared to dream at the start of my cholesterol journey did come true.’

Indeed, his dreams have been realised: he left a rich legacy of increased knowledge and awareness of FH and lipid disorders in the community, and a lifeline for the management of homozygous FH patients with dialysis. Presently LDL apheresis is carried out by nephrologists from the University of Malaya medical centre with the support of public funds and donations from the Heart Foundation of Malaysia through the sale of his book on cholesterol. Kah Lin Khoo was survived by his wife Yin Mei Liew and their two children.

Yin Mei Liew

[International Foundation News Malaysia Obituary Dato Dr Khoo Kah-Lin 20 November 2014 www.fh-foundation.org/news/malaysia-obituary-dato-dr-khoo-kah-lin – accessed 23 May 2016; The Star online 6 June 2012 www.thestar.com.my/lifestyle/health/2012/06/06/datuk-dr-khoo-kah-lins-contribution-to-society/ – accessed 23 May 2016]

(Volume XII , page web)

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