Heart Attacks are Preventable!

EP158: Fats, Oils, And Lipids

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 is a practicing cardiologist and author dedicated to educating patients about heart health. In this episode, he tackles the complex but important topic of hydrocarbons, fats, oils, and lipids, using creative metaphors to make the chemistry accessible. Dr. Bishop believes that understanding the language and science behind these compounds will help patients better understand nutrition, storage, and medical treatments related to cardiovascular health. Key Takeaways Hydrocarbons are molecules made up only of hydrogen and carbon atoms, forming the basis of fuels like petrol, and can be arranged in chains or rings. A useful way to understand hydrocarbons is to imagine carbon atoms as children with four arms that must always hold something (represented as hydrogen atoms or "hula hoops"). Saturated hydrocarbons/fatty acids have single bonds between carbon atoms and hold the maximum number of hydrogen atoms possible, typically solid at room temperature. Unsaturated fatty acids contain double bonds between some carbon atoms (where they "hold hands" with multiple arms), making them no longer hold the maximum hydrogen possible. Monounsaturated fatty acids have one double bond in the chain, while polyunsaturated fatty acids have multiple double bonds. Trans fats are created through chemical manipulation where the bonds between carbons are distorted (arms crossed), and these are associated with raising bad cholesterol and worse health outcomes. Cis bonds are the normal, natural bonds between carbon atoms (running parallel), whereas trans bonds result from artificial processing. Fatty acids are created by adding oxygen to hydrocarbon chains, specifically adding a hydroxyl group (oxygen and hydrogen together) to the end of the chain. Saturated fatty acids with 16 carbon atoms are solid at room temperature and are the main component of animal fats commonly seen in meat and bacon. Read more

EP157: Talking About Viagra

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 is a practicing cardiologist and author dedicated to patient education about heart health. In this episode, he provides a comprehensive overview of Viagra, discussing its mechanism of action, uses, availability, dosing, and important safety considerations—particularly for cardiac patients who may encounter dangerous drug interactions. Key Takeaways: Viagra (sildenafil) is a phosphodiesterase-5 inhibitor that increases nitrous oxide in blood vessels, relaxing them and improving blood flow to the penis and lungs. The drug was discovered by Pfizer in 1989 while researchers were actually searching for anti-anginal medications, making its primary use a serendipitous discovery. Alternative phosphodiesterase inhibitors exist in the market, including Levitra (which works more rapidly) and Cialis (which has a longer half-life). In Australia, Viagra can be accessed through prescription or online retailers, with 100mg tablets available cheaply; splitting higher-dose tablets with a pill cutter provides the most cost-effective option. Viagra is most effective for erectile dysfunction caused by psychological factors or age-related fatigue, not for dysfunction stemming from arterial disease or nerve damage, which require specialist evaluation. A critical warning exists against combining Viagra with nitrate-based medications (GTN spray, isosorbide mononitrate), as this combination can cause dangerous drops in blood pressure. Patients taking Viagra who develop chest pain and call an ambulance must inform paramedics about the medication to prevent life-threatening interactions with emergency GTN treatment. Viagra can cause side effects including facial flushing, vision and hearing issues, and priapus (prolonged, problematic erection), so first-time users should start with very low doses. Beyond erectile dysfunction, Viagra is prescribed for pulmonary hypertension, where increased blood flow to the lungs helps reduce dangerously high lung pressure. The medication should be taken approximately 30 minutes before use and remains effective for two to four hours. Read more

EP156: Palliative Care

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 is a practicing cardiologist and author dedicated to improving patient care through health education, believing that educated patients receive better healthcare. In this episode, Dr. Bishop discusses palliative care—a topic he encounters frequently in his cardiology practice and considers essential for patients with serious illnesses. He uses the World Health Organization's definition of palliative care as a framework to explain its importance and address misconceptions about end-of-life care. Key Takeaways Palliative care affirms that dying is a normal process of life, requiring us to acknowledge mortality as an inevitable part of existence rather than something to deny or ignore. Palliative care neither hastens nor postpones death; instead, it allows nature to take its course while supporting quality of life without artificially extending or shortening the dying process. Pain and distressing symptoms—including lung secretions affecting breathing, constipation, bloating, and fluid accumulation—can be effectively managed through various medical and non-pharmaceutical interventions. Palliative care addresses both psychological and spiritual needs of patients and families, recognizing that suffering extends beyond the patient to their loved ones. A multidisciplinary team approach including primary care doctors, specialists, palliative care physicians, nurses, occupational therapists, social workers, physiotherapists, and spiritual counselors provides comprehensive support. Improving quality of life through palliative care can positively impact the illness itself, even though prolonging life is not the goal. Palliative care should be initiated early in chronic illness—not just when patients are near death—to provide support during uncertain and difficult treatment phases. Major barriers to palliative care include insufficient open conversation about end-of-life planning and a critical shortage of palliative care physicians, particularly in rural and remote areas. Read more

EP155: Discussion With Dr. Karam Kostner About HDL 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. Podcast Summary Introduction Dr. Warrick Bishop, a practicing cardiologist and author dedicated to patient education about heart health, hosts this episode with special guest Dr. Karam Kostner, a cardiologist specializing in cholesterol and lipids. Together, they explore high-density lipoprotein (HDL) cholesterol—what it is, how it works, and what influences its levels in the body. Key Takeaways: HDL is called "good cholesterol" because it transports cholesterol back to the liver for excretion, acting as the body's natural regulator of cholesterol levels. HDL levels are primarily genetically determined, controlled by apolipoproteins like apolipoprotein A1, though lifestyle factors can modify these levels. HDL particle size and composition vary significantly—smaller HDL particles can be more effective at reverse cholesterol transport than larger ones, making HDL assessment more complex than LDL evaluation. Lifestyle factors that reduce HDL include smoking, obesity, and diabetes, while exercise, weight loss, and moderate alcohol consumption increase HDL levels. Hormonal changes such as menopause in women and testosterone use in men can negatively impact HDL levels. Common medications to raise HDL include niacin and fibrates, which are particularly useful for diabetics and those with metabolic syndrome; however, CETP inhibitors that dramatically increase HDL have not been shown to reduce cardiovascular events. Emerging experimental approaches like injecting apolipoproteins to create more effective HDL show promise in early trials but lack large-scale clinical evidence for practical use. HDL testing is minimally affected by fasting status (only about 5% variation), unlike triglyceride testing which requires fasting. While diets rich in monounsaturated fats and omega-3 oils may increase HDL, they often also increase LDL and total cholesterol, potentially negating protective benefits. HDL is protective only to a certain degree; high HDL cannot fully compensate for elevated LDL or other poor lipid profiles in preventing coronary disease. Read more

EP154: Moving Fat Around The Body - Lipoprotein

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 is a practicing cardiologist and passionate health educator who hosts this podcast to help patients understand their heart health through education. In this episode, Dr. Bishop explains how fats and lipids are transported throughout the body, building on previous discussions about hydrocarbons and basic fat chemistry. The episode focuses on the structure and function of lipoproteins—the specialized particles that act as delivery vehicles for fats and cholesterol in the bloodstream. Key Takeaways: Lipids (fats, cholesterol, and triglycerides) are hydrophobic (water-repelling) and cannot travel freely through the bloodstream, requiring special transport mechanisms. Phospholipids are unique because they have both hydrophobic and hydrophilic (water-attracting) properties, making them ideal for forming the outer shell of transport particles. Apolipoproteins are special proteins that can bind and carry hydrophobic lipids while remaining water-soluble, allowing them to transport fat through the aqueous bloodstream. Lipoproteins are spherical particles with a protein and phospholipid shell on the outside and a fatty core (triglycerides and cholesterol esters) on the inside. The density of a lipoprotein particle increases as fatty content is removed during transport, which is why we classify them as "low-density" or "high-density" based on their composition. Chylomicrons are the largest lipoprotein particles (approximately 500 nanometers in diameter), produced in the gut to transport absorbed dietary fats. Very Low-Density Lipoproteins (VLDL) are produced by the liver and transport triglycerides and cholesterol for distribution throughout the body. Lipoprotein lipase is an enzyme that breaks down and extracts fat from chylomicrons and VLDL particles at the capillaries, allowing tissues to access energy and storage lipids. Fat-soluble vitamins (A, D, E, and K) and antioxidants like vitamin E travel within lipoprotein particles as they move through the body. The apoprotein on each lipoprotein acts as a "key" that determines which tissue receptors the particle can bind to, directing lipids to their appropriate destinations. Read more

EP153: Angela Hartly interviews Dr Bishop on Diet Tips

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 Angela from Healthy Hearties interviews Dr. Warrick Bishop, a practicing cardiologist from Tasmania, Australia, who is passionate about patient education and heart health. In this episode, Dr. Bishop shares his key dietary recommendations and tips for patients looking to improve their cardiovascular health through nutrition. Key Takeaways: The Mediterranean diet is the proven best diet for heart health, supported by major research studies like PREDIMED (primary prevention) and Leon Heart Study (secondary prevention), and is superior to low-fat diets for reducing heart attack risk. Patients should prioritize eating green vegetables abundantly, as they are excellent for heart health and should form the foundation of their diet. Fruit should be consumed cautiously due to high sugar content, particularly for pre-diabetic patients or those seeking weight loss, making it less recommended than green vegetables. Carbohydrate consumption should be significantly reduced, as all carbs break down into simple sugars; major culprits include bread, pasta, rice, potatoes, cereals, and sugary foods like chocolate and biscuits. Healthy fats and foods like nuts, extra virgin olive oil, garlic, legumes, and avocados can be enjoyed freely as part of a Mediterranean-style diet. Regular exercise is essential and should be combined with a Mediterranean diet for optimal heart health outcomes. A moderate glass of wine (red or white) can be enjoyed with meals and may provide cardiovascular benefits, though individuals with atrial fibrillation or alcohol sensitivity should avoid it. Dr. Bishop is creating a "10 Commandments for Good Heart Health" podcast resource available free through the Healthy Heart Network membership, which can help patients track how many recommendations they're implementing. Patient education and personal responsibility are critical—Dr. Bishop emphasizes that while doctors provide the medication and guidance, patients must actively participate in their own health management. Read more

EP152: Angela Hartly Interviewing Dr Bishop - How Often Should You See Your Doctor?

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 is a practicing cardiologist based in Tasmania, Australia, who is passionate about patient education and heart health awareness. Angela from Healthy Hearties interviews Dr. Bishop about common patient questions regarding cardiology follow-up care and monitoring schedules. The episode addresses practical guidance on how frequently cardiac patients should see their cardiologist depending on their condition and stability. Key Takeaways: Follow-up frequency after hospitalization or intervention should be approximately two weeks to allow for therapy assessment and monitoring of potential side effects. Cardiac failure patients require intensive early management with frequent visits (1-2 weeks) to adjust medications, monitor electrolytes, and titrate doses to maximum tolerated levels. Once patients achieve stability on their treatment regimen, annual follow-up visits may be sufficient, provided they return immediately if symptoms change. Cardiologists should see patients annually even after stents or heart attacks to ensure they receive updated guideline-based treatments, as recommendations evolve with new research. Cholesterol targets and other clinical guidelines have changed significantly over the past 5-10 years, making periodic specialist review important. Phone consultations can be an effective tool for monitoring stable patients, allowing medication adjustments without requiring in-person visits. Patients should not self-discontinue medications due to side effects; instead, they should communicate with their doctor to discuss alternatives or dosage adjustments. Patients must actively advocate for themselves by seeking earlier appointments if they experience new symptoms rather than waiting for scheduled visits. Dr. Bishop has created the "Healthy Heart Network," a free online resource offering vetted podcasts, newsletters, and videos to help patients make informed decisions about their care. Read more

EP151: Interview With a Psychiatrist About Heart Problems

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 practicing cardiologist and patient education advocate, hosts this episode with Dr. Ralph Ilcheff, Director of Liaison Psychiatry at Royal North Shore Hospital in Sydney. The episode explores the critical mental health aspects of cardiac event recovery, examining how patients psychologically adapt to heart attacks and other cardiac emergencies and why psychiatric support is essential for optimal outcomes. Key Takeaways: About 20% of cardiac patients develop significant mental health problems such as depression, anxiety disorders, or post-traumatic stress disorder following a cardiac event, while most experience brief, self-correcting adjustment reactions. Cardiac events trigger a profound recognition of mortality and can involve a grieving process similar to other major losses, as patients adjust to changes in their health, well-being, and sense of invulnerability. Prior history of depression, anxiety disorders, or other mental health conditions significantly increases vulnerability to psychological complications after cardiac events and should be assessed before cardiac procedures through preventive screening. Well-designed cardiac rehabilitation programs are often the most effective intervention for patients experiencing adjustment reactions, providing both psychological and physical recovery support. Untreated depression and anxiety after cardiac events can negatively affect long-term health outcomes, requiring thoughtful, holistic rehabilitation approaches rather than simple medication or counseling alone. Strong social support from partners, family, and friends is equivalently important to cardiac function for psychological recovery and should not be overlooked in treatment planning. Relationship dynamics between patients and partners undergo significant stress during recovery as roles shift, requiring renegotiation of responsibilities and dynamics both during acute illness and as strength returns. Sexual dysfunction is a common but often under-addressed concern after cardiac events, arising from medication side effects, fear of triggering another episode, and mental health medications, requiring sensitive monitoring and discussion. While historical personality type theories (Type A) lack strong evidence, life adversity and previous struggles increase vulnerability to post-cardiac complications. Genetic risk factors within families warrant prevention discussions, making assessment of siblings' cardiac history important for long-term family health planning. Read more

EP150: Interview With Stent Patient Brian

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 practicing cardiologist and author dedicated to patient education about heart health, interviews Brian, a 59-year-old patient who recently underwent coronary stent placement. The episode follows Brian's journey from discovering a critical arterial narrowing through preventive screening to successful treatment, highlighting the life-saving value of proactive heart disease detection. Key Takeaways: Brian discovered a 95-99% narrowing in his left anterior descending artery (the "widow maker") despite having minimal symptoms—only slight breathlessness and heart arrhythmias during running. A CT calcium score, initially recommended by his GP years earlier but delayed, proved crucial in identifying arterial disease before a life-threatening heart attack could occur. Brian's family history of early cardiac death (no males past 50 on his father's side, his father's first heart attack at 49) made preventive screening particularly important. Despite being physically fit and maintaining an active lifestyle with surfing and bushwalking, fitness alone was not protective against significant coronary artery disease. The invasive coronary angiogram procedure was well-tolerated, described as painless and interesting, with sedation making the patient comfortable while remaining awake. Finding and treating the blockage during scheduled procedure time "between nine to five, Monday to Friday" avoided the risk of sudden cardiac death and emergency intervention. Brian's story emphasizes that subtle or easily-dismissed symptoms warrant medical investigation—his arrhythmias during beach runs proved significant despite his initial assumption they were harmless ectopic heartbeats. Patients with identified coronary disease should inform siblings and relatives to encourage them to pursue similar preventive screening given shared genetic risk factors. Proactive screening allows early detection when problems can be resolved electively rather than emergently, fundamentally changing patient outcomes. Brian's final advice: don't let busy life circumstances or reliance on physical fitness delay cardiac screening when risk factors like family history and cholesterol problems are present. Read more

EP149: Interview With Cardiothoracic Surgeon

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 practicing cardiologist and passionate health educator, hosts this episode featuring Dr. Ashtush Hardika, a cardiothoracic surgeon and colleague from Hobart, Tasmania. The episode focuses on the critical importance of cardiac rehabilitation in preventing second cardiac events, exploring how post-intervention care and lifestyle changes are essential to long-term patient outcomes. Key Takeaways: Cardiac interventions (stents, bypass surgery) are temporary fixes—described as "glorified plumbing jobs"—and must be followed by comprehensive rehabilitation programs to create lasting lifestyle changes and prevent second cardiac events. Cardiac rehabilitation should be built on three key components: Education (providing accurate, scientifically-sound information about disease and prevention), Exercise (personalized, supervised programs tailored to individual needs), and Emotional support/Counseling (addressing the psychological trauma and mental scarring from cardiac events). The emotional and psychological impact of cardiac events often exceeds the physical impact, and patients commonly experience a grieving process that requires recognition and support from healthcare providers. Stent patients may underestimate the severity of their cardiac event and be less motivated to change lifestyle habits, whereas cardiac surgery patients, facing greater physical recovery demands and visible scars, often experience stronger motivation for lasting behavioral change. A multidisciplinary team approach—including cardiologists, nurses, educators, dieticians, physiotherapists, occupational therapists, psychologists, and exercise specialists—is essential for effective cardiac rehabilitation delivery. Current funding models in Australia do not adequately match the need for comprehensive cardiac rehabilitation programs, despite cardiovascular disease accounting for over one-third of adult deaths. Ongoing follow-up and re-engagement with cardiac patients should occur at minimum every 12 months, with more frequent support needed for isolated patients or those struggling with behavior change (such as smoking cessation). A dedicated cardiologist with specialized interest in secondary prevention should lead rehabilitation programs to ensure consistent, evidence-based guidance toward specific health targets for each patient. Read more