Heart Attacks are Preventable!

EP318: Interview With Jason Curtis - Strength and Conditioning Coach (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. Podcast Summary Introduction Dr. Warwick Bishop, a cardiologist and CEO of the Healthy Heart Network, interviews Coach Jason Curtis, a strength and conditioning coach from the UK, in part two of their discussion. This episode focuses on the physiological principles of strength and conditioning training, practical program design for sedentary adults, and the science behind different types of muscle development and training outcomes. Key Takeaways: Clarifying fitness goals is essential before designing a program, as "fitness" is a broad term encompassing strength, aerobic capacity, and other factors that clients may weight differently in their priorities. Strength training involves progressively adding resistance to fundamental human movements like squats, lunges, hinge movements, pushing, and pulling—exercises people perform daily, just extended with greater range of motion. Progressive overload is the key principle for building strength and muscle and increasing bone density; external loads must be gradually increased over time to drive adaptation. Free weight training (barbells, dumbbells, kettlebells) provides superior benefits compared to machines by developing stability, coordination, and balance alongside strength gains. Load tolerance—the amount of force tissues can safely handle—is more often the limiting factor than movement itself; clients should start conservatively and progress slowly to avoid injury and maintain motivation. An effective program structure begins with strength training while fresh, followed by progressively challenging cardiovascular conditioning, starting with steady-state exercise before advancing to high-intensity work. Two one-hour sessions per week of strength training is optimal for most clients; even one hour weekly of progressive strength work produces meaningful improvements, while three or more sessions weekly can accelerate results if recovery is managed properly. Muscle hypertrophy (growth) can be developed across any repetition range as long as progressive overload is present, making program flexibility possible across different training styles. Strength development is best achieved with heavier loads and lower rep ranges (above 90% one-rep max), while endurance is best developed through higher repetitions and metabolic stress. Strength training should be viewed as a lifelong pursuit rather than a short-term program; sustainable, gradual progression over months and years outperforms aggressive short-term approaches that risk injury and burnout. Read more

EP317: Interview With Jason Curtis - Strength and Conditioning Coach (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 Dr. Auric Bishop (note: also introduced as Dr. Warwick Bishop), a cardiologist and CEO of the Healthy Heart Network, interviews Jason Curtis, a UK-based strength and conditioning coach with a military background. The episode explores Curtis's journey from six years as an army physical training instructor to founding his own gym eight years ago, and his current focus on developing "fitness racing"—a new sport combining gym-based exercises with competitive racing formats designed to appeal to the growing fitness community. Key Takeaways: Fitness racing represents a gap in the sports market by combining gym-based training exercises (farmer's carries, sled pushes, rowing) with competitive racing on low-technical-demand courses, making it accessible to average fitness enthusiasts rather than elite specialists. The civilian fitness population demonstrates greater intrinsic motivation and commitment than military personnel because they voluntarily pay for training, creating personal investment that translates to higher completion rates and better outcomes. Free or heavily discounted courses have dramatically lower completion rates compared to paid courses—paid participants consistently complete courses while free participants rarely do, demonstrating the psychological value of financial investment. Health span (quality of life during aging) has become the primary motivator for gym members, particularly in the 40-60 age group, surpassing aesthetic goals that dominate younger members' training priorities. Maintaining fitness levels as you age is actually an improvement because natural physical decline with aging means staying the same represents relative progress against the aging curve. Awareness of bone mineral density, muscle loss risks, and fall prevention—once specialized fitness knowledge—has become common knowledge among the general population through media and scientific research dissemination. Most gym members are now training for long-term health and functional ability rather than appearance, with mental health benefits from exercise serving as a secondary but significant motivator. Read more

EP316: Understanding Heart 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 316: Understanding Heart Health Summary Dr. Auric Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode dedicated to helping Australians understand cardiovascular health, particularly heart rate. The episode addresses common patient questions about what constitutes a normal heart rate, how it's measured, and what various heart rate readings mean for overall health, aiming to prevent the one heart attack that occurs every 20 minutes in Australia. Key Takeaways: Heart rate is simply the number of times the heart beats per minute, typically measured at the wrist, though this method can be unreliable during irregular rhythms like atrial fibrillation where an ECG provides more accurate measurement. A normal resting heart rate for most people ranges from 60-70 beats per minute, with rates below 50 potentially indicating high fitness levels or genetic predisposition, and rates consistently above 100 at rest warranting medical investigation. The predicted maximum heart rate can be estimated using the formula 220 minus your age, and moderate-intensity exercise targets should be between 50-70% of this maximum heart rate. Treadmill stress tests aim to elevate heart rate to approximately 85% of predicted maximum to properly stress the heart and reveal potential problems, similar to revving a car engine during a diagnostic test. Medications like beta blockers and calcium channel blockers that slow heart rate should be discontinued before diagnostic treadmill tests but continued if the test is for prognostic purposes in patients with known artery disease. Heart rate variability—the variation in time between heartbeats—is an emerging health indicator that reflects how well the body responds to environmental challenges, with low variability potentially signaling arrhythmias or neurological conditions. Wearable devices like the Apple Watch can monitor heart rate through photoplethysmograph technology, though concerns exist about accuracy and reproducibility, particularly in older populations who may need monitoring most. A 12-lead ECG remains the gold standard for evaluating heart rhythm concerns and should be performed when resting heart rate exceeds 100 beats per minute or falls below 50 to rule out underlying problems. Future health monitoring will increasingly incorporate heart rate variability analysis as a routine assessment tool for general cardiovascular and overall health evaluation. Read more

EP315: Stay in Your Lane

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 EP315: Stay in Your Lane Dr. Warrick Bishop, a cardiologist and CEO of the Healthy Heart Network, uses this episode to critique another podcast featuring a sports scientist interviewing a university lecturer about coronary artery disease. While both guests were highly qualified in their respective fields, Dr. Bishop expresses concern about how the lecturer's conclusions—particularly that excessive endurance exercise caused their high coronary calcium score and coronary artery disease—misrepresent the complexity of heart disease and could mislead listeners. The episode serves as a cautionary reminder about the importance of staying within one's expertise when discussing medical topics. Key Takeaways: Experts should stay within their lane of expertise; a sports scientist, however qualified, may not be the appropriate source for explaining coronary artery disease mechanisms High coronary calcium scores in people with seemingly healthy lifestyles often indicate underlying genetic factors like family history or lipid abnormalities (such as high lipoprotein A) rather than lifestyle alone The claim that excessive exercise caused coronary artery disease is likely incorrect; exercise is actually one of the most significant protective factors against heart disease Calcium in arteries can act as a stabilizer, converting unstable fatty plaque into more stable calcified plaque, which may explain why endurance athletes often have higher calcium scores A proper evaluation of high calcium scores requires comprehensive testing including lipid profiles, LDL/HDL cholesterol levels, lipoprotein A, vitamin D, and homocysteine—none of which were mentioned in the critiqued podcast Coronary artery disease is a focal process (affecting specific arterial locations), not a systemic, homogeneous distribution of inflammation throughout all arteries The "widow-maker" refers to a plaque lesion in the left anterior descending artery (a coronary artery disease problem), not a primary electrical rhythm disturbance as suggested in the podcast Listeners must critically evaluate health information from any source and seek clarification from appropriate medical experts, as misleading information can spread even when presented by well-intentioned, qualified individuals The complexity of coronary artery disease is poorly understood even by leading cardiologists, making oversimplified explanations particularly dangerous Read more

EP314: Navigating Heart Disease - Treatment Options and Beyond

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 EP314: Navigating Heart Disease - Treatment Options and Beyond Dr. Warwick Bishop, a cardiologist, CEO of the Healthy Heart Network, and author, hosts this episode to guide listeners through the journey of heart disease diagnosis and treatment. The episode provides a comprehensive overview of the treatment pathway that patients can expect when diagnosed with heart conditions, emphasizing that early intervention and lifestyle changes can prevent many cardiac events. Dr. Bishop covers the full spectrum of treatment options available today and hints at emerging therapies on the horizon. Key Takeaways: Lifestyle modifications form the foundation of heart disease treatment for virtually all cardiac conditions, including weight management, exercise, stress reduction, and alcohol avoidance Atrial fibrillation affects 300,000-400,000 Australians and up to 15% of people over 80, and can often be triggered by preventable factors like stress and alcohol consumption Cholesterol management through medication is central to treating patients with plaque buildup in arteries, with specific targets established for optimal outcomes Antiplatelet medications (like aspirin) reduce blood clotting by decreasing the stickiness of platelets, preventing dangerous clots in coronary arteries while allowing normal clotting at injury sites Procedural interventions range from diagnostic tests (treadmill tests, coronary angiograms) to therapeutic procedures (pacemakers, cardiac ablation for irregular rhythms) Coronary artery bypass grafting remains the most common cardiac surgery, requiring full sternotomy (splitting the breastbone) and often necessitating a heart-lung bypass machine Risk-benefit analysis is essential for all treatment decisions, and patients must be thoroughly informed and consented before undergoing any procedures or surgery Emerging therapies including gene therapy, stem cell therapy, and RNA-based interventions show promise for restoring or regenerating cardiac function in the near future Read more

EP313: The Brain and Low Cholesterol

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: "EP313: The Brain and Low Cholesterol" Dr. Warwick Bishop discusses a major scientific statement from the American Heart Association regarding the safety of aggressive cholesterol lowering and its effects on brain health. The episode addresses widespread concerns from statin skeptics who claim that lowering cholesterol increases risks of dementia and hemorrhagic stroke. Bishop reviews a comprehensive 39-page scientific statement by a writing group led by Dr. Larry Goldstein that evaluates contemporary evidence on this topic. Key Takeaways: LDL cholesterol lowering consistently reduces the risk of atherosclerotic cardiovascular disease events and heart attacks in high-risk populations, which remain major killers. While some older case-control studies suggested statins might cause cognitive impairment, larger observational studies and randomized controlled trials do not support this conclusion for medium-term follow-up periods up to six years. There is no robust evidence that aggressive LDL cholesterol lowering or statin therapy increases the risk of hemorrhagic stroke (brain bleeding) in patients without prior cerebrovascular disease. Populations with genetically lifelong low LDL cholesterol levels do not show enhanced vulnerability to hemorrhagic stroke, and achieving very low LDL levels does not increase this risk. Lower LDL cholesterol levels correlate with lower overall stroke risk and stroke recurrence, primarily through reduction in ischemic stroke (blockage-related stroke). Concerns about hemorrhagic stroke should not deter clinicians from treating LDL cholesterol to guideline-recommended targets for individual risk stratification. The American Heart Association statement received no commercial funding, indicating an unbiased scientific assessment representing the organization's official position. Individual patient responses vary; some patients report cognitive side effects that require case-by-case management, despite lack of population-level evidence. Additional long-term studies are needed, particularly regarding non-statin cholesterol-lowering agents like PCSK9 inhibitors in specific patient populations. Read more

EP312: QLD Lipid Meeting October 2023

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: EP312 - QLD Lipid Meeting October 2023 Introduction Dr. Warwick Bishop, a cardiologist, discusses highlights from the Queensland Lipid Group's annual meeting held October 20-21, 2023, featuring presentations from leading international and local experts. The episode covers cutting-edge developments in cholesterol management, lipid disorders, inflammation, and cardiac imaging, with a focus on practical applications for reducing cardiovascular disease risk. This comprehensive overview aims to share key clinical insights and emerging treatment options with healthcare professionals and health-conscious listeners. Key Takeaways: Inclisiran is a novel RNA-based therapy that specifically targets liver cells to increase LDL receptors, lowering cholesterol levels with a convenient dosing schedule of two initial injections 90 days apart, then every six months. High-risk patients often fail to reach appropriate LDL cholesterol targets within a year after cardiac events, highlighting the persistent challenge of cholesterol management and medication adherence. LP(a) (lipoprotein(a)) is an emerging cardiovascular risk factor with genetic components; testing costs approximately $60 out of pocket and should be considered for individuals with significant family history of premature coronary artery disease. The omega-3 index, measurable through a $100 blood test, is a significant predictor of sudden cardiac death, making it a valuable assessment for those seeking to optimize heart health through dietary intervention. Colchicine, traditionally used for gout, shows promise in reducing cardiovascular events by dampening the inflammasome, a molecular complex central to inflammation pathways. Current evidence on dietary inflammation is limited and not well-established; weight reduction and calorie control remain the only interventions with robust scientific support. Coronary artery calcium scoring blurs the line between primary and secondary prevention, as a score of 400 indicates risk equivalent to someone who has already experienced a coronary event. Mental health conditions show significant associations with diet and inflammation, suggesting an important intersection between psychiatry and cardiovascular risk management that warrants further investigation. Read more

EP311: Fat Bellies and Skinny Brains

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: Fat Bellies and Skinny Brains Dr. Auric Bishop, a cardiologist and CEO of the Healthy Heart Network, hosts this episode featuring a discussion on research linking abdominal fat to reduced brain volume. The episode analyzes a September 2023 Medscape article by Megan Brooks about a large study of 10,000 healthy middle-aged adults that examined the relationship between visceral and subcutaneous abdominal fat and brain atrophy. The discussion emphasizes how excess weight, particularly around the abdomen, may negatively impact cognitive function and brain health. Key Takeaways: Both visceral fat (fat around organs) and subcutaneous fat (fat under the skin) are associated with reduced brain volumes, including grey matter, white matter, and critical regions like the hippocampus and frontal cortex. Women showed higher burdens of brain atrophy with increased visceral fat compared to men, though researchers note more research is needed to fully understand these sex differences. The research examined 10,000 adults aged 20-80 using MRI imaging to measure actual fat volumes rather than BMI, providing a more precise assessment of body fat distribution. While the study shows statistically significant relationships between abdominal fat and brain volume reduction, individual effect sizes are generally small, meaning the impact varies from person to person. The study is cross-sectional in nature, which prevents definitive conclusions about causality and whether increasing fat directly causes brain shrinkage. The research did not account for important lifestyle factors such as physical activity, diet, genetic variation, and blood pressure, which could influence the observed associations. Rising obesity rates in Western countries are correlated with increasing rates of heart disease, stroke, type 2 diabetes, and cancer, making weight management crucial for overall health. Multiple factors beyond weight contribute to cognitive decline and dementia risk, including education level, physical activity, sleep quality, mental health, and previous head injuries. The Alzheimer's Association is conducting the US Pointer trial to investigate whether combining physical activity, healthy nutrition, social engagement, and improved medical self-management can enhance cognitive function in at-risk older adults. Maintaining a healthy weight through regular exercise, good nutrition, and cognitive engagement appears important for protecting both heart health and brain health throughout life. Read more

EP310: Common Cardiac Drugs and Common Interactions

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, a cardiologist, hosts this episode focused on common cardiac medications and their potential drug interactions. Dr. Auric Bishop provides context about the prevalence of heart disease in Australia, where a heart attack occurs every 20 minutes. The episode aims to educate listeners about how commonly prescribed heart medications work and, importantly, what interactions patients should be aware of when taking multiple drugs. Key Takeaways: Aspirin is widely used for both pain relief and blood thinning in coronary artery disease by reducing platelet stickiness, but should be taken with food or milk to minimize stomach upset from blocking prostaglandin protection. Combining aspirin with other blood-thinning drugs like clopidogrel or warfarin requires careful medical supervision due to increased bleeding risk. Warfarin's effectiveness is influenced by vitamin K intake from leafy greens and cruciferous vegetables, so consistency in dietary patterns is more important than complete avoidance. Many drugs interact with warfarin through liver metabolism, including antibiotics and anti-epileptic drugs, making it essential to inform your doctor of all medications. Proton pump inhibitors like omeprazole can theoretically reduce clopidogrel effectiveness, though clinical problems are rarely observed. Regular grapefruit juice consumption can dangerously increase blood levels of beta blockers, calcium channel blockers, and certain statins like atorvastatin and simvastatin. ACE inhibitors combined with potassium supplements or high-potassium salt substitutes can elevate potassium to dangerous levels, requiring regular kidney and potassium blood testing. Diuretics like frusemide cause potassium loss, which may need supplementation, especially when combined with ACE inhibitors that retain potassium. Sublingual GTN spray and nitrates can cause dangerous blood pressure drops when combined with phosphodiesterase inhibitors like Viagra, a critical interaction for emergency responders to know about. Amiodarone, used for heart rhythm problems, has complex drug interactions and should be taken on an empty stomach since high-fat meals increase its absorption and blood levels. Read more

EP309: 10 Commandments of Heart Health Explained

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 to address the epidemic of heart disease in Australia, where someone suffers a heart attack every 20 minutes. He presents the "Ten Commandments of Heart Health," key principles from his upcoming book designed to help people understand and manage their cardiovascular risk factors for better long-term health outcomes. Key Takeaways: Don't smoke; smoking is highly addictive (comparable to cocaine) but quitting is possible with proper support and motivation from loved ones. Exercise regularly for at least 20-30 minutes, three to five times per week—even brisk walking provides significant physical and mental health benefits, including reduced risk of heart attack, stroke, and dementia. Eat well and maintain a healthy weight by avoiding processed foods with additives and artificial sweeteners, which can have unexpected metabolic consequences; losing excess weight early prevents your body from adjusting to an unhealthy set point. Limit alcohol consumption; recent research shows no amount of alcohol is beneficial, and any consumption may increase blood pressure, atrial fibrillation risk, weight gain, and dementia risk. Keep blood pressure under control through regular monitoring, as high blood pressure increases risks of stroke, heart attack, atrial fibrillation, heart failure, kidney damage, and dementia. Manage diabetes risk by monitoring blood sugar and HbA1c levels, especially if overweight or with a family history of diabetes, as weight loss can prevent diabetes development. Know your precise cardiovascular risk by going beyond population-based risk calculators to actual arterial imaging (calcium scoring) to identify plaque in your specific arteries. Know your cholesterol level and act on it; use imaging combined with cholesterol management to make informed decisions about treatment and medication needs. Understand aspirin and heart medications; aspirin is not broadly indicated for intermediate-risk individuals but may be appropriate for those with high-risk imaging findings. Build a support team including family, friends, your GP, and specialists (cardiologist, exercise physiologist, psychologist) to sustain lifestyle changes and share knowledge with others for collective health improvement. Read more