Heart Attacks are Preventable!

EP55: Talking About Supplements

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: EP55 - Talking About Supplements Dr. Warwick Bishop is a practicing cardiologist and author dedicated to improving patient care through education about heart health. In this episode, he addresses common patient questions about supplements for cholesterol management, specifically discussing bergamot and other natural alternatives to traditional statin therapy. The discussion centers on how to safely and effectively incorporate supplements into a cardiovascular health regimen based on individual risk assessment. Key Takeaways: Bergamot, a citrus-based plant containing flavonoids, has demonstrated cholesterol-lowering effects in research, with studies showing reductions of 0.5-1 millimole per litre and improvements in carotid artery thickness. The effectiveness of any supplement depends on the patient's individual cardiovascular risk level; high-risk patients (those who have had heart attacks) require aggressive LDL lowering and may need statins combined with supplements, while low-risk patients may benefit from supplements alone. When using supplements like bergamot, it is critical to use formulations that actually work—Dr. Bishop recommends using the specific proprietary preparation (BurgerVit) tested in research and monitoring cholesterol levels to verify effectiveness. Red yeast rice, which naturally contains the chemical precursor to statins, can be a supportive option for cholesterol management but may be insufficient as a standalone treatment for high-risk patients. Berberine appears to have lipid-lowering effects that partially replicate PCSK9 inhibitors (newer injectable cholesterol medications) and may have a role in comprehensive cholesterol management. Nicotinic acid (niacin), a B-group vitamin, can modestly lower LDL cholesterol, raise HDL cholesterol, and lower triglycerides, with particular benefit shown in the HATS trial for patients with low HDL cholesterol. Any supplement use should be done in collaboration with a cardiologist or healthcare provider who can monitor its effectiveness, check for side effects, and ensure it doesn't negatively impact organs like the kidneys and liver. Dr. Bishop recommends patients work with both a knowledgeable naturopath and their cardiologist when using supplements, as he acknowledges he cannot stay current with all formulations and proprietary preparations available. Statins remain the gold standard for cholesterol lowering in high-risk patients, but supplements can be valuable additions to a structured, supervised treatment plan when appropriate. The overall approach should balance the patient's actual cardiovascular risk with the intensity of treatment needed, rather than applying one-size-fits-all solutions to cholesterol management. Read more

EP54: Cholesterol Tests: The Good, The Bad, And The Ugly

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 is a practicing cardiologist and author dedicated to improving patient care through heart health education. In this episode, he provides a comprehensive breakdown of cholesterol tests, explaining what each component measures and why understanding these numbers matters for assessing cardiovascular risk. Key Takeaways: Fasting for 8 hours before a cholesterol test is optimal; fasting longer than 12-14 hours can skew results as the body makes metabolic adjustments. Total cholesterol measures all cholesterol in the blood and should ideally be around 5-5.5 millimoles per litre. Triglycerides are free fats in the bloodstream and should be below 2 millimoles per litre; elevated levels may indicate recent eating, diabetes risk, or excess weight. HDL cholesterol is "good cholesterol" that removes cholesterol from tissues and returns it to the liver; levels should ideally exceed 1 millimole per litre. LDL cholesterol is "bad cholesterol" because extensive research shows that lowering it in high-risk patients leads to better health outcomes. The cholesterol ratio (HDL to total cholesterol) should be less than 4, as lower ratios indicate a more favorable lipid profile. Primary prevention guidelines recommend LDL cholesterol targets below 2 millimoles per litre, while secondary prevention (after a cardiac event) targets below 1.8 millimoles per litre. Emerging research suggests even lower LDL targets below 1 millimole per litre may benefit high-risk patients with no adverse effects. Dr. Bishop prefers fasting cholesterol tests because they allow simultaneous measurement of glucose and insulin levels to calculate insulin resistance using the HOMA calculation. Cholesterol numbers alone don't tell the complete story; blood pressure, blood glucose, insulin levels, and lifestyle factors are equally important for cardiovascular health assessment. Read more

EP53: What Is 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 Introduction Dr. Warwick Bishop is a practicing cardiologist and author dedicated to educating patients about heart health, believing that informed patients receive better care. In this episode, he provides a foundational explanation of cholesterol—its chemical nature, biological functions, and how the body transports and manages it. Key Takeaways: Cholesterol is a steroid alcohol, a fatty compound that serves as an essential building block for cell membranes throughout the body. The body uses cholesterol to produce bile acids in the liver, which help break down and transport fats through the digestive system for removal. Cholesterol is a precursor for steroid hormones, including sex hormones like estrogen and testosterone. Because cholesterol is water-insoluble, the body requires special transport molecules called lipoproteins to move it through the bloodstream. The body produces the vast majority of its cholesterol internally through metabolic processes in the liver, with genetics playing a major role in determining production levels. Low-density lipoprotein (LDL) is the primary carrier that transports cholesterol from the liver to body tissues and is the type associated with coronary artery disease risk. High-density lipoprotein (HDL) performs reverse cholesterol transport, picking up excess cholesterol from tissues and returning it to the liver for disposal. Cholesterol metabolism involves three interconnected processes: endogenous production in the liver, exogenous consumption from diet, and reverse cholesterol transport back to the liver. Statin medications work by blocking the HMG-CoA enzyme, which reduces the body's internal cholesterol production. Read more

EP52: Wishes At End Of Life

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. EP52: Wishes At End Of Life - Summary Dr. Warwick Bishop is a practicing cardiologist and author dedicated to educating patients about heart health and improving their care. In this episode, he addresses end-of-life wishes and Medical Orders for Life Sustaining Treatment (MOLST) forms, exploring both their benefits and limitations in documenting patient preferences during critical illness. Drawing on nearly 30 years of experience in end-of-life care decisions, Dr. Bishop advocates for thoughtful, ongoing conversations rather than relying solely on standardized forms. Key Takeaways: MOLST forms provide valuable documentation of patient and family wishes, allowing specific preferences like refusing blood products or resuscitation to be clearly recorded in medical notes. Forms are inherently "brittle" and cannot easily capture the nuances and complexities of individual patient situations or reflect moment-to-moment changes in medical conditions. The presence of a MOLST form noting "no resuscitation" can create a subconscious perception among ward staff that leads to a step-down in overall care quality for patients. Timing matters critically—filling out MOLST forms during a patient's first hours in the hospital creates uncomfortable conversations and puts pressure on junior doctors, patients, and families who are unprepared. End-of-life conversations require deep understanding built over time; Dr. Bishop is only comfortable having these discussions with patients he has known for months or years. Most patients prioritize living with dignity and functionality, wanting to avoid becoming "a vegetable" or entirely dependent on machines or other people. Decision-making about end-of-life care should be flexible and adaptive, made as challenges arise rather than fixed in advance, because medical situations can change unpredictably. Dr. Bishop recommends discussing end-of-life preferences with family broadly rather than waiting for a crisis, allowing people to express their values before facing critical illness. Read more

EP51: Aspirin: Good or Bad?

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 EP51: Aspirin: Good or Bad? Dr. Warwick Bishop is a practicing cardiologist and author dedicated to educating patients about heart health. In this episode, he addresses recent media headlines questioning aspirin's benefits by examining three major clinical trials—ASPRI, ARRIVE, and ASCEND—that collectively studied over 45,000 patients to clarify when aspirin is actually beneficial and when it isn't necessary. Key Takeaways: Recent headlines warning against aspirin are based on large, robust trials (ASPRI, ARRIVE, ASCEND) showing that healthy individuals and average-risk patients don't need aspirin for disease prevention. The ASPRI trial of 20,000 people over age 70 found that regular aspirin didn't improve quality of life, cardiovascular outcomes, or reduce dementia in healthy elderly individuals. The ARRIVE trial showed aspirin reduced heart attack risk in intermediate-risk patients but offered no significant benefit for stroke and came with increased bleeding risk. The ASCEND trial of over 15,000 asymptomatic diabetics over seven years showed aspirin was not compelling for primary prevention in this population. Aspirin remains strongly beneficial in secondary prevention—for patients who have already experienced a heart attack, stroke, stent placement, bypass surgery, or peripheral vascular disease. Dr. Bishop prescribes aspirin in primary prevention only for high-risk patients he has imaged and confirmed have significant plaque buildup in their coronary arteries. The key message is that aspirin decisions should never be based on headlines alone but require individualized conversations between patients and their doctors about specific risk-benefit ratios. Patients currently taking aspirin prescribed by their doctor should not stop without consulting their physician, as the recent trials don't apply to those with existing cardiovascular disease or high-risk imaging findings. Read more

EP50: 50th Podcast

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: EP50: 50th Podcast Introduction: Dr. Warwick Bishop is a practicing cardiologist and author dedicated to improving patient care through heart health education. In this milestone 50th episode, he celebrates nearly a year of weekly podcasting and reflects on his growing community engagement, including his new role as AMCAL's Heart Health Ambassador and plans to launch an internet-based membership site called the Healthy Heart Network. Key Takeaways: Dr. Bishop has successfully released 50 weekly podcasts over nearly a year, establishing himself as a consistent educator in cardiac health The podcast has reached hundreds of downloads with an engaged community including nearly 1,000 members in the Know Your Real Risk of Heart Attack Facebook group Dr. Bishop has grown his professional network to nearly 4,000 LinkedIn connections and regularly sells e-books internationally, indicating global interest in his content He was appointed as AMCAL's Heart Health Ambassador, expanding his platform and credibility in cardiac health education Dr. Bishop spent time in the United States recording a 13-episode TV series called "The Healthy Heart Network TV Show" to expand his educational reach The upcoming Healthy Heart Network membership site will provide comprehensive, up-to-date information and resources for people seeking quality heart health guidance Dr. Bishop emphasizes that educated patients consistently receive better healthcare outcomes, making patient education his core mission He encourages listener feedback and welcomes questions about topics for future podcast episodes to ensure content relevance Read more

EP49: Takotsubo or Broken Heart Syndrome

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 is a practicing cardiologist and author dedicated to patient education in heart health, hosting this episode to discuss Takotsubo Syndrome, commonly known as Broken Heart Syndrome. The episode explores how severe emotional stress can trigger a heart condition that mimics a heart attack but is caused by nervous system and hormonal responses rather than blocked arteries. This educational discussion aims to help patients understand this rare but important cardiac condition. Key Takeaways: Takotsubo Syndrome (Broken Heart Syndrome) is triggered by significant emotional stress in approximately 70% of cases, such as fights, distressing life events, surgical anxiety, or intense emotional situations like soccer games. The condition predominantly affects middle-aged women, though it can occur in men at much lower frequency. Takotsubo presents identically to a heart attack with chest pain, ECG changes, and elevated troponin levels in blood tests, making it difficult to distinguish without further investigation. The characteristic feature is "apical ballooning," where the heart base functions normally but the apex (tip) balloons outward, resembling an octopus pot—the Japanese origin of its name. Takotsubo is caused by excessive nervous system activity and stress hormones from the adrenal glands affecting heart muscle function, not by blocked coronary arteries. The diagnosis is made by exclusion—patients must show all features of a heart attack while having clear, unblocked coronary arteries. The condition is relatively rare, occurring in approximately 5-10% of people presenting with apparent heart attack symptoms, and is rarely fatal. Most patients recover fully within several months, and recurrent episodes occur in only about 10% of cases. Treatment involves medications for heart failure and beta-blockers to reduce nervous system activity and hormonal impact on the heart. Follow-up care includes coronary angiography or CT imaging to rule out blocked arteries, plus an ultrasound and ECG at three months to confirm full heart recovery. Read more

EP48: Can We Reverse Coronary Artery Disease?

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 is a practicing cardiologist and author dedicated to educating patients about heart health. In this episode, he discusses whether coronary artery disease can be reversed, sharing two compelling patient cases that demonstrate the real-world effectiveness of aggressive cholesterol management and lifestyle modifications in reducing arterial plaque. Key Takeaways: Coronary artery disease plaque can actually regress and be reversed through aggressive cholesterol management, statins, and other pharmaceutical interventions combined with lifestyle changes. Peter's case demonstrates significant plaque regression in his left main artery over several years of compliant cholesterol-lowering therapy, to the point where his native artery may now be supplying more blood flow than his bypass graft. Aggressive intervention and monitoring for cardiovascular risk is beneficial even before symptoms appear, as demonstrated by Phil's preventive care approach when soft plaque was detected during routine screening. Soft (non-calcific) plaque is the most dangerous type because it can rupture, making its reduction through treatment a major health victory. Calcified plaque, while indicating disease presence, is actually a marker of stability and represents a positive transformation when soft plaque converts to calcium through treatment. Educated, compliant patients who maintain target cholesterol levels consistently see better outcomes and can actually reverse the arterial disease process. Cholesterol-lowering medications like statins and ezetimibe, when combined with proper diet, exercise, and triglyceride management, have proven effectiveness in clinical practice beyond just theoretical studies. Regular follow-up imaging (CT scans, angiograms) allows doctors to monitor plaque progression and adjust treatment targets as guidelines evolve and improve. Read more

EP47: Beating The Same Old Drums

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 47: Beating The Same Old Drums - Summary Dr. Warwick Bishop is a practicing cardiologist and author dedicated to improving patient care through heart health education. In this episode, he passionately addresses two recurring frustrations from his clinical practice: patients who don't know their medications and those who unilaterally stop taking prescribed drugs without consulting their doctor. Through real patient examples, Dr. Bishop emphasizes the critical importance of medication awareness and informed decision-making in cardiac care. Key Takeaways: Patients should maintain an up-to-date written list of all medications and keep it in their wallet for emergencies and medical consultations. Not knowing what medications you're taking prevents doctors from accurately diagnosing medication side effects and making informed treatment decisions. Pharmacy staff can be valuable resources for obtaining clear, accurate medication lists that patients can carry with them. Medication lists can be lifesaving in emergency situations when patients are unable to communicate their medical history themselves. Preventative medications like statins don't produce noticeable daily effects, making patients question their necessity—but they work to extend lifespan over time. Patients should never unilaterally stop medications based on social media, anecdotal neighbor experiences, or general information that doesn't account for their specific clinical situation. Open dialogue between patients and doctors about medication concerns is essential before making any changes to prescribed treatments. Doctors prescribe medications based on careful risk-benefit analysis tailored to individual patient circumstances, not arbitrary decisions. Patient education about the difference between symptom-relieving drugs and preventative drugs can improve medication compliance and long-term health outcomes. Medical decisions should be collaborative, informed discussions between healthcare providers and patients rather than unilateral patient choices. Read more

EP46: Responding To A Facebook Group Question About Calcification

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 is a practicing cardiologist and author dedicated to patient education in heart health, hosting this podcast to help people understand cardiovascular concepts. In this episode, he addresses multiple questions from his Facebook community about vascular and cardiac terminology, breaking down complex medical concepts related to arterial disease, calcification, and treatment options. Key Takeaways: Calcification is a marker of plaque buildup in arteries, where calcium binds to cholesterol deposits and can be used to detect atherosclerosis in the heart and other arteries Claudication refers to burning or cramping pain in the legs during exercise, caused by narrowed arteries restricting blood flow—essentially "angina of the legs" A bypass is a surgical procedure using another vessel (conduit) to route blood around a blocked or diseased artery segment, from a healthy area before the blockage to a healthy area after it Bypass grafts in the heart typically use veins from the legs, arteries from the arm, or arteries from inside the chest wall, while leg bypasses may use synthetic Dacron material Angioplasty is a procedure that opens narrowed arteries by inflating a balloon, which deploys a stent that acts as a scaffold to keep the artery open Modern angioplasty differs from older techniques by combining balloon inflation with stent deployment in a single procedure rather than using balloons in isolation A calcified aorta indicates plaque buildup within the aortic wall and suggests potential disease, loss of elastic tissue, and possible enlargement of the aorta Read more