Heart Attacks are Preventable!

EP75: Bad Joints, Good Heart, Glucosamine

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 cardiovascular health expert, hosts the Healthy Heart Network podcast. In this episode, he explores recent research on glucosamine—a popular supplement commonly used for joint and cartilage health—and its potential cardiovascular benefits. The discussion centers on a recent UK meta-analysis of glucosamine trials that suggested a possible reduction in cardiovascular events among users. Key Takeaways: Recent pooled data from approximately 15 glucosamine trials suggests a potential reduction in cardiovascular events among glucosamine users Glucosamine likely exerts anti-inflammatory effects, which may be beneficial since inflammation plays a role in plaque formation and coronary disease The landmark Cantos trial demonstrated that targeted anti-inflammatory agents (canakinumab) significantly reduced cardiovascular events, providing strong evidence that inflammation is a key factor in heart disease Current research is exploring other anti-inflammatory agents like colchicine (traditionally used for gout) as potential cardiovascular treatments While the glucosamine data is promising and theoretically sound, it remains speculative and should not yet be considered standard therapy for heart disease prevention Glucosamine appears to be safe for cardiovascular health with no adverse effects observed in current data People taking glucosamine for joint pain can do so with confidence, knowing it may offer modest cardiovascular benefits as an added bonus Further trials are ongoing to better understand the relationship between anti-inflammatory interventions and cardiovascular disease prevention Read more

EP74: Antiplatelet With Antibiotic Action - Serendipity In Action

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 hosts the Healthy Heart Network podcast/videocast, where he discusses recent cardiology news and research. In this episode, he shares a fascinating discovery about Ticagrelor, an antiplatelet medication commonly used after acute coronary syndromes, which researchers have observed may have unexpected antibiotic properties against multidrug-resistant bacteria. Key Takeaways: Ticagrelor, an antiplatelet drug given to patients receiving stents after heart attacks or unstable angina, was observed to correlate with lower infection rates in those patients compared to those who didn't receive it. Researchers followed up on this observation by conducting structured studies to investigate whether Ticagrelor actually has antibiotic properties beyond its known effect on blood platelets. Ticagrelor appears to have an antimicrobial mechanism of action that is completely separate from its P2Y12 receptor activity used to prevent blood clotting in stents. The drug demonstrates particular promise against multidrug-resistant bacteria, which have developed resistance to many modern antibiotic therapies—a major clinical problem. The therapeutic doses required to kill bacteria in petri dish studies are far too high for safe human use, as they would cause dangerous bleeding. The goal of future research is to identify and isolate the specific antibiotic component of Ticagrelor so it can be purified separately from its antiplatelet effects. Scientists aim to develop a new class of antibiotic therapy based on the active ingredient from Ticagrelor, potentially targeting difficult multidrug-resistant gram-positive bacteria. This discovery represents an example of serendipitous scientific discovery, where an incidental observation led to a potentially groundbreaking therapeutic avenue. Read more

EP73: SAMHRI Meeting - May 10 & 11, 2019

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 educator who believes that informed patients receive the best healthcare. In this episode, he shares key insights and learnings from the South Australian Heart and Medical Research Institute weekend conference (May 10-11), which covered cholesterol management, prevention strategies, peripheral vascular disease, cardiac failure, and heart attack treatment across a broad range of cardiovascular topics. Key Takeaways: PCSK9 inhibitors can safely lower LDL cholesterol to very low levels (around 0.6 mmol/L) in high-risk post-heart attack patients, reducing future cardiac events, with genetic evidence showing no harm even at levels as low as 0.25 mmol/L. Current Australian guidelines recommend LDL cholesterol below 1.8 mmol/L for post-event patients, but emerging research suggests lower targets may be more beneficial. Sodium-glucose transport blockers (SGLT2 inhibitors) are a new drug class that helps diabetics while also providing cardiac failure benefits, but requires careful monitoring to prevent ketoacidosis with normal blood sugar. The REDUCE-IT trial demonstrated that high-dose EPA (fish oil component) significantly benefits patients with high triglycerides over a 10-year period, though the mechanism and patient selection criteria remain not fully understood. Cholesterol crystals within arterial plaque trigger inflammation, and agents like colchicine (historically used for gout) may help reduce this inflammatory response. Lowering LDL cholesterol to very low levels does not cause memory or cognitive problems, as confirmed by the Ebbinghaus study and genetic evidence. Managing patients with atrial fibrillation who require stents is complex and controversial, requiring balance between anticoagulation (for stroke prevention) and antiplatelet therapy (to prevent stent clotting). The Global Leaders Trial showed that Ticagalor as a single agent worked better than standard regimens at 12 months but lost efficacy by 24 months, suggesting potential long-term compliance issues. Cardiac failure treatment involves numerous options including ACE inhibitors, AT2 blockers, spironolactone, beta blockers, SGLT2 inhibitors, and iron infusions, requiring careful individualized management. Read more

EP72: We Can Do Better

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 heart health education. In this episode filmed from the Maldives, Dr. Bishop shares two case studies that illustrate gaps between optimal cardiac care and current clinical practice, highlighting the importance of patient advocacy in healthcare decisions. Key Takeaways: Stress tests alone are insufficient for assessing arterial health; they only detect significant blockages that are already late in the disease process and may miss early plaque buildup. Patients with family history of heart disease should advocate for direct imaging of their arteries rather than relying solely on functional tests like treadmill assessments. Performing stress tests on asymptomatic patients who are clearly fit may reflect business interests rather than genuine clinical necessity. CT coronary angiography (with contrast) provides valuable information about plaque presence and quantity, enabling better risk stratification and treatment intensity decisions. A 30% arterial narrowing on CT imaging is non-flow-limiting and will not cause symptoms, as approximately 70% narrowing is needed to produce hemodynamic obstruction. Proceeding to invasive coronary angiography after a non-flow-limiting finding on CT without symptoms constitutes over-servicing and carries unnecessary risks to patients. Invasive coronary angiography cannot show greater detail than CT for a 30% lesion and is therefore an inappropriate follow-up test in asymptomatic patients. Over-servicing wastes community resources and increases individual patient costs while exposing patients to unnecessary procedural risks. Patients must actively ask questions and seek appropriate imaging to ensure they receive evidence-based care aligned with their actual risk profile. Healthcare technology must be used with integrity and clinical judgment to serve patient outcomes rather than financial incentives. Read more

EP71: The Italian Hour - Interview With Renato Delfatti

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 who joins host Renato to discuss heart health education and disease prevention. The episode centers on Dr. Bishop's book "Have You Planned Your Heart Attack?" and explores why early detection and understanding of arterial health is crucial, even for apparently fit individuals. Dr. Bishop emphasizes that educated patients receive better healthcare outcomes and advocates for preventive scanning and lifestyle modifications before heart problems develop. Key Takeaways: Fitness and healthy appearance do not guarantee protection against heart attacks; arterial health is not always reflected by external health indicators. Plaque buildup in arteries is a complex process involving cholesterol deposits that can block blood flow, but can be modified through medication and cholesterol-lowering strategies. Early detection of plaque through advanced imaging allows for intervention before a heart attack occurs, making preventive scanning and monitoring worthwhile. Plaque can be reduced or even reversed in some patients when cholesterol is lowered sufficiently, as demonstrated through serial scanning and clinical experience. There is a significant gap between cutting-edge medical technology and widespread adoption by general practitioners due to lack of established guidelines and slow implementation timelines. Patient education and informed understanding of heart health conditions empowers individuals to have meaningful conversations with their doctors and actively participate in prevention strategies. A heart attack (medically termed myocardial infarction) occurs when lack of blood flow damages heart muscle; the underlying issue involves arterial blockage rather than sudden failure. Dr. Bishop's book uses accessible language, humor, cartoons, and real stories to make complex cardiac concepts understandable to non-medical audiences. Free resources including a 12-13 episode TV series and book previews are available on Dr. Bishop's website (www.drWarrick.com) to help people learn about heart health before committing to the full book. Long-term medication compliance and lifestyle changes are essential for managing cholesterol and preventing heart disease, rather than short-term interventions. Read more

EP70: Cholesterol: Confusion And Controversy

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 and improving heart health outcomes through informed decision-making. In this episode, Dr. Bishop addresses the confusion and controversy surrounding cholesterol management and statin therapy by exploring why polarized opinions exist among patients despite established medical guidelines. The episode was prompted by heated discussions in his Facebook group "Know Your Real Risk of Heart Attack," particularly from a member named Jeff who held strong anti-statin views based on personal research. Key Takeaways: Cholesterol is an association with heart disease, not a direct causation—meaning high cholesterol increases risk at the population level but doesn't guarantee individual heart attacks. For patients with established heart disease (prior heart attack, stent, or bypass), lowering cholesterol with statins is clearly supported by 30-40 years of research and significantly improves outcomes. Treatment decisions should distinguish between high-risk and low-risk patients—those with existing arterial plaque benefit most from cholesterol-lowering therapy, while asymptomatic patients with only elevated cholesterol require more careful consideration. Before treating high cholesterol in otherwise healthy individuals, discussion with a GP or specialist (lipidologist/preventative cardiologist) is valuable to assess actual risk. Arterial imaging tests can help determine if cholesterol plaque buildup is actually present, informing whether aggressive treatment is necessary for asymptomatic patients. Treatment decisions must account for multiple risk factors including blood pressure, smoking, diabetes, exercise level, medication side effects, and individual health objectives. Statins are both effective and safe in treating patients with established heart disease, with strong evidence supporting their use. Patient education and informed discussion reduce polarization—patients should seek reliable information sources rather than relying on anecdotal internet research. Read more

EP69: CTCA Risk Consultation

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, believing that educated patients receive the best care. In this episode, he conducts a consultation interview with his patient Wayne and Wayne's wife Maureen, sharing Wayne's preventative cardiology journey after discovering significant coronary artery disease during routine screening at age 65. The episode highlights the importance of proactive heart health assessment and the life-changing impact of preventative imaging. Key Takeaways: Preventative cardiac imaging can detect serious conditions in asymptomatic patients who might otherwise walk out of a GP appointment and collapse without warning. Wayne's intuition about needing a "proper heart check" led him to seek advanced imaging rather than relying solely on traditional GP assessments like blood pressure checks and stethoscope examination. CT coronary angiography revealed substantial plaque buildup in Wayne's left main coronary artery—a critical finding that without treatment could have resulted in sudden cardiac death as his first cardiac event. Not all cardiologists emphasize preventative imaging; some colleagues offer only treadmill tests, meaning patients could receive different management strategies depending on which specialist they consult. Aggressive cholesterol-lowering therapy is particularly beneficial for patients with documented arterial plaque, as it can stabilize and potentially reduce plaque burden over time. The controversy surrounding statin side effects is often overstated; Wayne experienced no side effects, and the decision to use statins should balance individual risk-benefit rather than relying on generalized concerns. Preventative cardiac screening costs ($600-700) represent excellent value when considered as an investment in decades of life expectancy and safety, comparable to spending on vehicle maintenance. Delay in seeking preventative care is common; Wayne contemplated getting screened for five years before finally acting, highlighting the need for patients to prioritize health assessment earlier. Regular surveillance through repeat stress testing and imaging every couple of years allows doctors to monitor plaque progression and adjust treatment strategies accordingly. Patients should prioritize seeking preventative cardiac assessment if they have risk factors, as early detection transforms cardiovascular risk from "unacceptably high with no awareness" to substantially reduced risk with active management and education. Read more

EP68: Stoppping Drugs If A Sick Heart Gets Better

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, Dr. Bishop discusses dilated cardiomyopathy—an enlarged heart with poorly functioning muscle—and importantly, what patients should do if their condition improves. He explores the causes, treatments, prognosis, and recent research findings that challenge common assumptions about medication management. Key Takeaways: Dilated cardiomyopathy is defined as an enlarged heart with dysfunctional muscle, primarily measured by ejection fraction (the percentage of blood pumped with each heartbeat). A normal ejection fraction is approximately 60%; less than 40% indicates cardiomyopathy, with worse disease showing progressively lower ejection fractions. Common causes include infections, alcohol abuse, certain chemotherapy drugs, prolonged elevated heart rates, genetic factors, and idiopathic (unknown) origins. Treatment involves medications that reduce blood pressure and workload on the heart, regulate heart rate, and modulate hormonal influences, including beta blockers and newer agents like Secubitril/Valsartan combinations. Prognosis has improved significantly—more than 50-60% of patients now show recovery compared to the historical "one-third rule," with improvement typically visible within three to six months. The TREND-HF study demonstrated that nearly 40% of patients relapsed when medications were withdrawn after heart function improved, proving long-term medication adherence is essential. Even when the heart recovers to near-normal function, patients should remain on medications indefinitely rather than discontinuing therapy. Read more

EP67: Mary - Cardiac Failure

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 education, believing that informed patients receive better healthcare outcomes. In this episode, he introduces his podcast channel focused on helping people understand heart health and the latest advances in cardiac care. Dr. Bishop uses the compelling case study of his patient Mary to illustrate a transformative lesson about patient-centered cardiac failure management that fundamentally changed his approach to treatment. Key Takeaways: Patient engagement and education are critical to preventing hospital readmissions; Mary's understanding of her condition made her an active partner in her own care management. Cardiac failure causes fluid retention in the body that accumulates in the lungs and legs, resulting in breathing difficulties and physical swelling that significantly impacts quality of life. Frequent hospital admissions (every 4-6 weeks in Mary's case) can be reduced through a simple at-home medication adjustment protocol based on patient-observed symptoms. Patients are often best positioned to monitor their day-to-day condition and notice early warning signs of deterioration before symptoms become severe. A flexible diuretic dosing strategy—where patients double their fluid medication at the first sign of swelling or shortness of breath—can prevent the progression of acute episodes. Once fluid retention is resolved and normal symptoms return, patients can safely return to their baseline medication dose under clear medical guidance. Cardiac failure affects approximately 1 in 10 people aged 75 and older and accounts for about 10% of Western healthcare budgets, making it an increasingly critical health issue. Home-based cardiac care management is preferable to clinic or hospital-based care when properly structured and monitored. Cardiac failure is rapidly becoming a pandemic and overtaking coronary artery disease as the leading heart-related condition in developed nations. Read more

EP66: Statin Therapy In Australia: What's New?

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 Dr. Warrick Bishop, a practicing cardiologist and author, hosts this episode to educate patients about heart health and recent changes in Australian healthcare policy. In this episode, he discusses a significant update to Australia's Pharmaceutical Benefits Scheme (PBS) regarding the availability and prescription of statins for cholesterol management. The primary focus is how the removal of eligibility restrictions on generic statins as of October 1, 2018, represents a major step forward in preventative cardiology. Key Takeaways: The PBS (Pharmaceutical Benefits Scheme) regulates pharmaceutical funding in Australia and is closely monitored due to its enormous cost to taxpayers and the government. Previous statin eligibility criteria, established in October 2006, required patients to have symptomatic conditions (heart disease, stroke, or blocked arteries) before accessing cholesterol-lowering drugs. The 2006 criteria also included specific high-risk groups such as diabetics, Aboriginal and Torres Strait Islanders, and those with strong family histories of early coronary artery disease. Patents on statins have expired since 2006, allowing generic versions to be manufactured at significantly lower costs by multiple pharmaceutical companies. As of October 1, 2018, the PBS removed all eligibility restrictions for statins, while other cholesterol-lowering drugs still maintain restrictions due to higher costs and lack of generic alternatives. The removal of restrictions enables doctors to prescribe statins based on clinical judgment and individual risk assessment, rather than waiting for patients to develop symptoms. This policy change is significant for preventative cardiology, as early intervention based on imaging results showing arterial plaque buildup can now occur without patients having to self-fund treatment. Dr. Bishop emphasizes the importance of sharing this information with the public and medical professionals, as many people may still be unnecessarily paying out-of-pocket for statins. Read more