Heart Attacks are Preventable!

EP334: Death & Dying Part 1

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary EP334: Death & Dying Part 1 Dr. Auric Bishop hosts this podcast featuring James Buckley, a personal guidance counselor specializing in meditation, hypnosis, and spiritual teachings. The episode explores the complex emotional and psychological aspects of death and dying—a topic Bishop has been hesitant to address despite his focus on helping people "live as well as possible for as long as possible." Both Bishop and Buckley share recent personal experiences with loss, including the deaths of Bishop's mother and his partner's mother, and Buckley's great aunt, which prompted this candid conversation about grief and mortality. Key Takeaways: Death and dying remain a societal taboo that prevents people from developing healthy coping mechanisms, leading to greater difficulty when loss inevitably occurs Different types of death (expected vs. sudden, at old age vs. young age) create distinctly different grief responses and emotional processing for those left behind Grief involves grieving both the loss of the person and the loss of future shared experiences and opportunities that will never happen The five stages of grief (denial, anger, bargaining, depression, acceptance) provide a framework for understanding the grieving process, though people don't necessarily move through them in a linear fashion Anger in the grieving process is often repressed sadness—a protective mechanism that shields people from confronting deeper emotional pain Bargaining is the psychological process of reconciling loss by finding meaning or justification for what happened (e.g., "they lived a good life," "they died doing what they loved") Depression following grief makes sense because it reflects the realization of permanent loss and the inability to have future experiences with loved ones Acceptance is not a final endpoint but rather an ongoing process with varying degrees; some losses remain harder to accept than others Breath work and somatic practices can help process grief held in the body and release trapped emotion from the grieving experience Discussing death openly and preparing psychologically for mortality helps people develop resilience and better coping tools before loss occurs Read more

EP333: Two Case Studies For Your Interest

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary Dr. Rick Bishop, a cardiologist and CEO of the Healthy Heart Network, presents two contrasting case studies demonstrating how personalized, bespoke approaches to cholesterol management are essential since different patients respond differently to treatment. The episode emphasizes that individual health management cannot be one-size-fits-all and highlights the critical importance of blood pressure control and cholesterol management in preventing cardiovascular events. Key Takeaways: Health investments made today are investments in future health—what you do now determines your health outcomes 5-10 years from now, and once health deteriorates, time cannot be reversed. Blood pressure control is critical because elevated blood pressure increases risk for heart attack, stroke, renal failure, atrial fibrillation, cardiac failure, and dementia, yet is easy to treat with modern medications. Dual blood pressure therapy using lower doses of two synergistic medications is preferable to maximizing a single agent, as it improves efficacy while minimizing side effects. Cardiac CT imaging is a valuable diagnostic tool for patients with risk factors (family history, elevated cholesterol, elevated blood pressure), providing centile comparisons to peers and revealing true cardiovascular risk. Statin side effects are real and individual—when one statin causes problems, alternative statins with different chemical properties (like switching from lipophilic atorvastatin to lipophobic rosuvastatin) may be better tolerated. Alternate-day dosing of statins can prevent medication buildup in the bloodstream and allow patients who are sensitive to statins to achieve cholesterol control without side effects. Adding ezetimibe as an adjunct therapy to statins provides synergistic effects and additional LDL cholesterol reduction without significant side effects. Getting LDL cholesterol below 2 millimoles per liter can slow or arrest plaque formation in high-risk patients. Women die from coronary artery disease at rates comparable to men, yet cardiovascular disease in women receives less public awareness than other conditions like breast cancer despite being the leading cause of female death in the Western world. Ketogenic diets can be effective for significant weight loss but often result in high saturated fat intake, which can elevate cholesterol levels and may offset some cardiovascular benefits gained from weight reduction. Read more

EP332: The Importance of Exercise With Dr Jason Kaplan

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode with Dr. Jason Kaplan, a fellow cardiologist focused on preventative cardiology. The episode centers on exercise as a critical tool for cardiovascular health and disease prevention, featuring an extended mock patient consultation demonstrating how cardiologists prescribe exercise to patients with intermediate-to-high cardiovascular risk. Key Takeaways: If the cardiovascular benefits of exercise were bottled into a drug, it would become the world's best-selling medication due to its myriad biological effects on multiple body systems, not just the heart. The heart can remodel and improve its size and pumping function through athletic activity up to age 70, making it never too late to achieve cardiovascular improvements. Patients need specific exercise prescriptions rather than vague advice to "just exercise," tailored to their individual circumstances and cardiovascular risk profiles. For intermediate-to-high risk patients, baseline cardiovascular testing such as stress echocardiograms is important to establish safety and identify any lack of blood supply to the heart before beginning an exercise program. Moderate-intensity aerobic exercise of 150-300 minutes per week (such as walking at 4 km/h or recreational cycling) provides significant cardiovascular benefits and should feel like "zone two" effort where you're slightly puffed but can still talk. High-intensity interval training of 75-150 minutes per week achieves similar cardiovascular benefits to moderate exercise and is a practical alternative for time-constrained individuals. Aerobic exercise is more powerful than resistance training for improving blood pressure and endothelial function (artery lining health), though resistance training should complement aerobic activity. A maximum heart rate can be estimated using the formula 220 minus age, with most training occurring at 70-85% of maximum heart rate, though this is a general guide with individual variation. Cardiorespiratory fitness is directly correlated with cardiovascular longevity—the fitter someone is aerobically, the longer they will live. Exercise supplements medical treatment of cardiovascular risk factors by helping to lower blood pressure, improve cholesterol profiles, and facilitate weight loss while improving overall quality of life. Read more

EP331: Who Is At Risk of Thin Bones?

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary: Who Is At Risk of Thin Bones? Dr. Auric Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode to educate listeners about bone health risk factors. As a partner in OsteoStrong, a franchise business focused on improving bone health, balance, and strength, Dr. Bishop draws on guidelines from the Australian Family Physician to explain who should be screened for osteoporosis and osteopenia. The episode provides practical information to help individuals assess their bone health risk and determine whether bone mineral density (DEXA) testing might be appropriate. Key Takeaways: Anyone over 70 years of age is considered a reasonable candidate for bone mineral density testing, while women over 50 and men over 60 with risk factors should also be screened. Women experience bone health problems earlier than men (due to menopause and lower baseline bone density), while men experience cardiovascular problems earlier than women—a 10-year difference reversal between the two conditions. Smoking and excessive alcohol consumption (2-4 standard drinks per day) reduce bone mineral density by disrupting the balance between osteoblasts and osteoclasts. Medical conditions including endocrine disorders (early menopause, thyroid issues, hyperparathyroidism), inflammatory diseases (rheumatoid arthritis, inflammatory bowel disease), chronic kidney disease, and liver disease significantly increase osteoporosis risk. Corticosteroid medications—commonly used for asthma and other lung diseases—are major risk factors for reduced bone mineral density and warrant earlier screening. SSRIs (selective serotonin reuptake inhibitors), widely prescribed antidepressants, may warrant bone density assessment due to their potential impact on bone health in a large population. Proton pump inhibitors used long-term for acid reflux can reduce calcium absorption and negatively impact bone mineral density over time. Anti-epileptic medications, anti-androgens, anti-estrogens, and excessive thyroxine therapy can all alter bone mineral density through various mechanisms. Sedentary lifestyle accelerates bone loss, while maintaining physical activity from age 25-30 onward slows the rate of bone mineral density decline. Inadequate calcium intake, low body weight, eating disorders, and increased fall risk are important lifestyle and nutritional factors that may necessitate bone density screening. Read more

EP330: Safe Lower Limits For Cholesterol Treatment

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary: Safe Lower Limits For Cholesterol Treatment Dr. Auric Bishop, a cardiologist and CEO of the Healthy Heart Network, hosts this episode with Dr. Warwick Bishop discussing how low LDL (bad) cholesterol can safely be lowered in patients. The episode addresses common concerns about aggressive cholesterol management using newer medications like PCSK9 inhibitors, examining whether extremely low cholesterol levels pose risks to normal bodily functions. Key Takeaways: Newborns naturally have very low LDL cholesterol levels (around 1.5-1.8 mmol/L) during their most metabolically active growth phase, suggesting the body functions normally at these low levels. Genetic studies using Mendelian randomization show that people with naturally very low cholesterol levels live long, normal lives without cardiovascular disease or problems with sex hormones, brain function, or nutrient absorption. Clinical trials with statins plus ezetimibe demonstrated that 37% of patients achieved cholesterol levels of 1.3 mmol/L or lower over 5-7 years with no adverse events and significantly reduced cardiovascular disease recurrence. Research shows cardiovascular benefits continue down to extremely low LDL cholesterol levels of 0.2 mmol/L with no evidence of hormonal, functional, or cognitive problems. PCSK9 inhibitors lower cholesterol without the diabetes risk mechanism associated with statins, indicating that low cholesterol itself does not cause diabetes development. Detailed neuropsychological testing in over 1,200 patients showed no cognitive decline or brain fog associated with very low cholesterol levels achieved through PCSK9 inhibitors. Systematic reviews show statins are associated with decreased dementia risk, including Alzheimer's disease and vascular dementia, rather than increased risk. Sex hormone production is more closely linked to HDL (good) cholesterol than LDL cholesterol, so aggressively lowering LDL has minimal impact on hormonal function. Read more

EP329: Bloods For Bone Health

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary EP329: Bloods For Bone Health Dr. Auric Bishop, a cardiologist and CEO of the Healthy Heart Network, discusses the essential blood tests for evaluating bone health in patients with suspected osteopenia or osteoporosis. With statistics showing that 40% of women and 30% of men will experience an osteopenic or osteoporotic fracture in their lifetime, Dr. Bishop emphasizes the importance of early detection through bone mineral density (DEXA) scans and follow-up blood work to assess underlying causes and risk factors. Key Takeaways: Osteopenia and osteoporosis are prevalent conditions affecting approximately 40% of women and 30% of men over their lifetime, making early screening and intervention critical regardless of current symptoms. DEXA (dual x-ray absorption) scans are the gold standard for measuring bone mineral density and cost approximately $150-200 out of pocket without Medicare rebates, providing a baseline comparison to a healthy 30-year-old. Kidney function tests (ECU—electrolytes, creatinine, and urea) are essential first-line blood work to rule out renal impairment, which can affect calcium metabolism and bone health. Liver function tests (LFTs) including alkaline phosphatase should be checked, as liver health is central to bone metabolism and calcium regulation. Calcium, magnesium, and phosphate (CMP) levels must be monitored together as they interact significantly; abnormal calcium may indicate hyperparathyroidism or renal problems requiring further investigation. Thyroid function (TSH) is critical because excess thyroid hormone increases bone turnover and can accelerate osteoporosis development over time. Vitamin D deficiency is common, particularly in cooler climates like Hobart during winter, and adequate vitamin D is essential for calcium reabsorption and bone health. Sex hormones (testosterone, estradiol, progesterone) and their markers (DHEAS, FSH, LH) directly influence bone mineral density, making hormonal assessment particularly important for women approaching or in menopause. Erythrocyte sedimentation rate (ESR) serves as a general inflammatory marker; significantly elevated levels warrant further investigation as they may indicate conditions like myeloma, which can cause osteoporosis-like skeletal changes. A comprehensive bone health evaluation should include growth hormone markers (insulin-like growth factor-1) and, for men, annual PSA testing to monitor prostate health, as these factors impact bone metabolism. Read more

EP328: Discussing Statin Intolerance

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. EP328: Discussing Statin Intolerance Dr. Auric Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode featuring a detailed discussion on statin intolerance with his guest Warwick. The episode explores why patients report difficulties with cholesterol-lowering medications and examines the scientific evidence behind these reported side effects. The core theme challenges the widespread perception that statins are poorly tolerated, presenting research suggesting that psychological factors play a major role in reported adverse effects. Key Takeaways: The Odyssey Alternative Trial found that 78% of patients initially reporting statin intolerance were actually able to tolerate statins when properly tested, compared to the 100% who claimed intolerance at entry. A Cleveland Clinic observational study showed that 72% of self-reported statin-intolerant patients could take statins without problems when blinded to treatment. The Samson Trial demonstrated a "nocebo effect," where approximately 90% of reported statin side effects were attributable to negative expectations rather than the medication itself. In the Samson Trial, symptom scores increased from 8 out of 25 with no treatment to 15.4 on placebo, suggesting that psychological anticipation drives most reported symptoms. Statins are often wrongly blamed for side effects that actually result from other medical conditions, as illustrated by a patient whose leg pain was caused by severe lumbar spine problems, not statins. Alternative therapies like PCSK9 inhibitors (such as elirocumab) provide options for truly statin-intolerant patients, though their high cost limits widespread use. Reducing statin dosing frequency to twice or three times weekly can allow up to 60% or more of patients to achieve therapeutic benefits while minimizing perceived side effects. Almost all medications can cause side effects in some populations, and statin intolerance should be confirmed through rigorous testing rather than accepted based on patient reports alone. Read more

EP327: Statins, Co Enz, Q10, Sams and Metformin

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary Introduction Dr. Warwick Bishop hosts this episode focused on cardiovascular health and metabolic management, exploring the relationships between statins and coenzyme Q10, as well as the broader therapeutic potential of metformin. The episode examines recent research on how these medications affect muscle function, oxidative stress, and metabolic health, while emphasizing evidence-based approaches to disease prevention. Key Takeaways: Coenzyme Q10 (ubiquinone) is found throughout the body and is essential for mitochondrial function, but statin use significantly reduces muscle levels of this compound. A 12-week study found that baseline muscle coenzyme Q10 levels were lower in statin users compared to non-statin users, but these levels did not differ between those who experienced statin-related muscle symptoms and those who didn't. Exercise training increased muscle coenzyme Q10 levels across all groups regardless of statin use, suggesting that the lower coenzyme Q10 levels in statin users may not be the primary cause of muscle side effects. Moderate-intensity exercise is an effective strategy to boost muscle oxidative capacity and counteract oxidative stress associated with statins, benefiting all individuals regardless of medication use. Metformin demonstrates benefits beyond diabetes management, with emerging evidence suggesting potential reductions in cancer risk and Alzheimer's disease through improved insulin and glucose control. The benefits of metformin appear to be most pronounced in overweight individuals with prediabetes or insulin resistance, rather than as a universal preventive medication. Metformin is already established as beneficial for managing obesity, polycystic ovary syndrome, gestational diabetes, and weight gain from antipsychotic medications. The therapeutic effects of metformin likely stem from reducing hyperinsulinemia and elevated glucose levels, which contribute to cellular dysfunction across multiple organ systems. Read more

EP326: Conference Time

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary EP326: Conference Time Dr. Warwick Bishop hosts this episode, sharing his experiences and key learnings from the NCC (National Cardiac) Congress held in Sydney on March 2-3, 2024. The episode features detailed insights from world-renowned cardiologists and specialists who presented on cutting-edge cardiac care, including genetic risk assessment, new cholesterol-lowering therapies, women's cardiovascular health, heart failure management, and innovative approaches to rural healthcare delivery. Key Takeaways: Holistic patient care is essential—specialists must look beyond their particular expertise to address all aspects of a patient's health, including blood pressure, diabetes, weight, mental health, and general well-being. Polygenic risk scores could help stratify patients for earlier screening; rather than using fixed age-based imaging protocols, genetic risk scores could identify which age groups need arterial imaging (e.g., imaging high-risk individuals at 35 versus standard protocols at 50+). Research suggests a potential link between LDL particles and amyloid protein, indicating that cardiovascular health and brain health are interconnected and deserve integrated research and treatment approaches. Small interfering RNA (siRNA) molecules represent an exciting breakthrough in treating dyslipidemia, with potential applications expanding to triglycerides, lipoprotein A, and even hypertension management. siRNA therapies can be administered every 6-12 months with prolonged cellular effects, dramatically improving medication adherence and treatment efficacy compared to daily medications. Women receive better cardiovascular outcomes when treated by female physicians, yet women's heart disease remains under-researched and under-resourced globally, with insufficient female cardiologists in the field. Ventricular assist devices (mechanical pumps) for heart failure have advanced significantly, with the longest recorded use reaching 18 years, and success depends on maximizing guideline-directed medical therapy including beta-blockers and SGLT2 inhibitors. Mobile cardiac clinics (like the Heart of Australia Truck) effectively bring specialized cardiovascular care to remote rural areas, identifying high-risk patients who would otherwise lack access to screening and intervention. Lipoprotein A is approximately six times more atherogenic than standard LDL cholesterol and represents a significant cardiovascular risk factor requiring targeted management strategies. Social media presents a double-edged sword for medical communication—while it enables patient engagement with quality health information, it also exposes clinicians to potential misinformation and malicious attacks. Read more

EP325: Gladiator and Trainer to the Stars: Lourene Bevaart (Part 2)

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary EP325: Gladiator and Trainer to the Stars: Lourene Bevaart (Part 2) Dr. Auric Bishop, a cardiologist and CEO of the Healthy Heart Network, hosts this episode featuring Lourene Bevaart, a world champion karate athlete, former gladiator, and fitness trainer to celebrities like Russell Crowe. In this second part of their conversation, Lourene discusses her career pivot from elite athletic training to helping people improve their health and wellness through education about cellular health and redox signaling molecules. Key Takeaways: Lourene experienced a major life pivot when she became a single mother, prompting her to find flexible work-from-home solutions centered on health and wellness that would allow her to earn income while raising her daughters. Redox signaling molecules are nano-sized molecules inside cells that detect, repair, and replace damaged cells; humans lose approximately 10% of these molecules every decade, which contributes to visible and invisible signs of aging. The analogy of aging cells to an outdated iPhone illustrates how reduced cellular capacity leads to decreased function—similar to how an old phone can't perform like a new model, aging bodies struggle to perform their optimal functions. Protein is critical for satiety and metabolism; Lourene recommends consuming 15-20 grams of protein with each meal or snack, with her personal minimum being 140 grams daily from varied sources including Greek yogurt, eggs, fish, and plant-based options. Chronic dehydration is widespread, and proper hydration with added minerals and electrolytes is essential for optimal health and athletic performance. A comprehensive health approach includes hydration, adequate protein intake, quality sleep, resistance training, and supplementation with redox signaling molecules to accelerate cellular repair and overall health transformation. Redox signaling molecules are unique supplements—not herbs, plants, or synthetic compounds—that are biochemically identical to molecules naturally present in human cells and can be taken as liquid or topical gel formulations. Many people fail to implement simple health steps (hydration, nutrition, exercise) while engaging in counterproductive behaviors like consuming alcohol and junk food, then wonder why they experience weight gain, sluggish metabolism, and persistent cravings. The redox field is relatively new (established in 2010) but growing rapidly with university studies, books, and conferences dedicated to understanding its therapeutic potential for general health and athletic performance. Read more