Heart Attacks are Preventable!

EP394: The REAL Truth About 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: EP394: The REAL Truth About Cholesterol Introduction Dr. Auric Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode focused on demystifying cholesterol and its role in heart health. With heart disease claiming a life every 20 minutes in Australia, the episode addresses widespread confusion about cholesterol, cholesterol-lowering medications, and how to properly assess individual cardiovascular risk. The discussion aims to move beyond oversimplified messaging to help listeners understand the complex relationship between cholesterol levels and actual arterial health. Key Takeaways: Cholesterol itself is essential for hormone production, vitamin D formation, and transporting fat-soluble vitamins, but LDL and HDL are transport vehicles (lipoproteins), not cholesterol itself. The common belief that "all LDL is bad and all HDL is protective" is oversimplified; some people have high LDL but healthy arteries, while others have low LDL but significant plaque buildup. Coronary artery calcium scoring and ApoB particle counts are more reliable predictors of heart disease risk than cholesterol levels alone. For secondary prevention (patients who've already had a heart event), lowering cholesterol is unquestionably beneficial and supported by 30+ years of research. Primary prevention (before any heart event) is more complicated and requires personalized assessment rather than blanket recommendations based solely on cholesterol numbers. Advanced imaging of arteries combined with risk calculators provides crucial information to determine who actually needs cholesterol-lowering therapy before experiencing an event. Triglyceride levels and the triglyceride-to-HDL ratio serve as important markers of metabolic health and cardiovascular risk. Cholesterol is only one piece of the heart disease puzzle; inflammation, insulin resistance, and plaque stability are equally important factors. Social media misinformation creates unnecessary confusion, particularly around primary prevention decisions and statin therapy. Individual-by-individual assessment with balanced, sensible approaches—rather than polarizing viewpoints—leads to the best health outcomes. Read more

EP393: Dietary Influences on Pancreatic Cancer and Heart Failure: Salt, Vitamin E, and Plant-Based Diets

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. Auric Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode alongside Warwick to discuss evidence-based dietary and lifestyle factors affecting cardiovascular health and cancer risk. The episode covers five major health topics: salt reduction, bone health, pancreatic cancer screening, heart failure treatment advances, and plant-based diet adequacy. Dr. Bishop emphasizes his mission to help people "live as well as possible for as long as possible" by providing actionable health information grounded in recent research. Key Takeaways: Salt substitutes using potassium chloride instead of sodium chloride reduce stroke risk by 15% and death risk by over 10%, making them a valuable intervention for cardiovascular health. Most dietary salt comes from processed and packaged foods rather than salt shakers, so reading food labels and advocating for legislation mandating salt substitutes in processed foods could have significant public health impact. Vitamin E does not improve bone mineral density and may even reduce it at high levels; instead, focus on vitamins D and K2 for optimal bone and vascular health. Pancreatic cancer is particularly difficult to diagnose early (only 15% caught early enough to impact survival) because of its deep abdominal location, though it can be associated with smoking, alcohol, obesity, and family history or BRCA genes. Heart failure with preserved ejection fraction (diastolic dysfunction) is increasingly common in aging populations, but new medications including empagliflozin, dapagliflozin, semaglutide, tirzepatide, and finerenone now offer better treatment options. Weight management and proper blood pressure control are the most effective ways to prevent heart failure with preserved ejection fraction in the first place. Plant-based diets are nutritionally adequate when properly planned with professional nutritionist guidance to address potential deficiencies in B12, iron, calcium, omega-3 oils, zinc, iodine, and protein. Plant-based diets are associated with lower cardiovascular event risk and cardiometabolic disease while reducing overall inflammation, a central driver of chronic disease. Read more

EP392: HDL, Vitamin D, and Triglycerides

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 dedicated to helping Australians understand cardiovascular health. With heart disease claiming one life every 20 minutes in Australia, Dr. Bishop focuses on educating listeners about preventable risk factors. This episode explores three interconnected topics: HDL cholesterol function, vitamin D's role in bone health, and triglycerides as metabolic health indicators. Key Takeaways: HDL cholesterol's protective benefits depend on functionality, not just quantity—some people with genetically high HDL levels have dysfunctional particles that increase inflammation and cardiovascular risk rather than reducing it. Drugs developed to raise HDL cholesterol have not demonstrated clear reductions in heart attack rates, suggesting that simply elevating HDL levels is insufficient without ensuring particle function. Vitamin D does not directly build bone but instead facilitates calcium absorption in the gut, making it available for osteoblasts (bone-building cells) to use during bone formation. Vitamin D serves a paradoxical role by both supporting bone building through calcium availability and removing calcium from bones to maintain critical blood calcium levels. Triglycerides are the body's primary fat transport mechanism and rise significantly when carbohydrates (including sugar) and alcohol are consumed, as the liver converts these into triglyceride packages. High triglycerides indicate metabolic dysfunction and serve as a "canary in the mineshaft," signaling insulin resistance, fatty liver risk, prediabetes, and poor lifestyle choices. Elevated triglycerides are often accompanied by low HDL levels and trigger changes in LDL particle size from large, benign particles to small, dense particles that pose greater arterial risk. Reducing carbohydrate and alcohol intake combined with regular exercise can dramatically lower triglycerides, with omega-3 fish oil supplementation providing additional support. The total cholesterol-to-HDL ratio remains a reasonably robust predictor of cardiovascular risk for most people, though individual variations exist. Dr. Bishop's forthcoming book "Cholesterol Explained" (mid-2025) addresses myths surrounding cholesterol, statins, and cardiovascular disease in greater detail. Read more

EP391: Gut Microbiome, Blood Pressure, and Mental Wellbeing

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: EP391 - Gut Microbiome, Blood Pressure, and Mental Wellbeing Dr. Auric Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode focused on three interconnected pillars of health: gut microbiome, blood pressure management, and mental wellbeing. Dr. Bishop emphasizes that understanding and managing these areas is crucial for preventing cardiovascular disease, which claims one life every 20 minutes in Australia and is largely preventable through lifestyle knowledge and intervention. The episode explores how these three health domains are deeply interconnected and collectively influence overall quality of life and longevity. Key Takeaways: The gut is often called the "second brain" because it contains extensive nerve tissue, glial cells, and neurons similar to those found in the brain. The gut microbiome consists of bacteria, viruses, and fungi that play crucial roles in digestion, immune function, inflammation control, blood sugar regulation, and neurotransmitter production, including serotonin. Damaging the gut microbiome can lead to "leaky gut," where unfiltered molecules enter the bloodstream, triggering inflammation, insulin resistance, and even altered brain function. Fiber intake, fermented foods (kimchi, yogurt, cultured vegetables), eating a rainbow of colors, and avoiding excess salt and unnecessary antibiotics are key strategies for maintaining a healthy microbiome. Blood pressure is a "silent killer" and one of the most powerful predictors of heart attack, stroke, kidney disease, and dementia; even a 10% reduction in blood pressure significantly decreases arterial wear and tear. Mental wellbeing directly impacts physical health—depression increases heart attack and stroke risk, while anxiety and chronic stress elevate cortisol and blood pressure levels. Strong interpersonal relationships are among the most significant factors for longevity according to the Harvard longevity study. Improving physical health through better sleep, nutrition, and movement simultaneously improves mental health; conversely, poor sleep and poor diet negatively impact both inflammation and mood. Loneliness, social isolation, and chronic mental stress all drive inflammation, elevate blood pressure, and increase cardiovascular events. These three health domains—gut, blood pressure, and mental wellbeing—are deeply interconnected and create a synergistic effect; addressing all three together produces optimal long-term health outcomes. Read more

EP390: Commotio Cordis and Nocturnal Leg Cramps

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: "EP390: Commotio Cordis and Nocturnal Leg Cramps" Dr. Auric Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode alongside Dr. Warwick Bishop to discuss two cardiac and muscular health conditions affecting Australians. The episode covers commotio cordis—a rare but life-threatening condition caused by blunt chest trauma—and nocturnal leg cramps, a much more common issue affecting up to 40% of adults over 50. Key Takeaways: Commotio cordis is a rare cause of sudden cardiac death in young athletes, occurring when blunt force trauma to the chest disrupts the heart's electrical rhythm and causes cardiac arrest. In the United States, only an estimated 10-20 cases of commotio cordis occur annually, though this may be under-reported; it predominantly affects males under 20 years old. Sports involving high-speed projectiles such as cricket, baseball, hockey, and lacrosse carry higher risk of commotio cordis, though chest protectors can reduce but not eliminate the risk. Automated external defibrillators (AEDs) at sporting venues are critical for commotio cordis survival, as accessing one within 180 seconds significantly improves survival chances and functional outcomes; beyond this window, brain damage risk increases substantially. Nocturnal leg cramps affect approximately 40% of adults over 50 and can be triggered by dehydration, electrolyte imbalances, poor circulation, nerve dysfunction, and certain medications including statins, diuretics, and beta blockers. The most evidence-supported treatment for nocturnal leg cramps is regular calf stretching before bed, performed with both straight and bent knees to target the gastrocnemius and soleus muscles for at least 30 seconds each. Magnesium supplementation may help reduce nocturnal leg cramps, though evidence is limited; vitamin K2 (menaquinone) shows promising recent research and may be beneficial when combined with vitamin D supplements. Patients experiencing leg cramps should review medications with their doctor, as certain drugs may be contributing to symptoms and could potentially be adjusted or changed. Read more

EP389: Inflammation, CAC & Metabolic Dysfunction

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. Auric Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode alongside Warwick to discuss three critical cardiovascular health topics: inflammation, coronary artery calcium (CAC) scoring, and metabolic dysfunction. The episode aims to help listeners understand how these interconnected factors contribute to heart disease risk and what actionable steps they can take to reduce their risk. Key Takeaways: Inflammation is a major driver of heart attacks, often triggered by plaque rupture rather than gradual arterial narrowing, and can result from stress, poor sleep, visceral fat, and chronic conditions like diabetes and autoimmune disorders. Sleep quality, regular exercise, stress management, and dietary modifications—including reducing salt intake—are all effective lifestyle strategies for reducing inflammation. Coronary artery calcium (CAC) scoring is a superior risk assessment tool compared to traditional population-based risk scores because it directly visualizes arterial plaque in individuals rather than relying on general statistics. A CAC score of zero indicates low short-term risk over the next five years, even with elevated cholesterol or pre-diabetes, while a score of 300 or higher indicates risk equivalent to someone who has already had a cardiac event. People with a CAC score around 100 should be considered for aspirin therapy and other preventive treatments due to significantly elevated risk. Metabolic dysfunction—characterized by central weight gain, elevated triglycerides, low HDL cholesterol, high fasting glucose, and high blood pressure—often precedes diabetes and carries similar heart disease risks. Individuals with pre-diabetes features face the same cardiovascular risk as those with diagnosed diabetes, despite not yet meeting diagnostic criteria, making early intervention critical. Metabolic dysfunction fuels inflammation and plaque formation, increasing risks for heart disease, stroke, dementia, and cancer even before progressing to full diabetes. Simple lifestyle modifications—reducing carbohydrates, limiting alcohol, and exercising regularly—can effectively address metabolic dysfunction and reduce associated risks. The Virtual Heart Check platform (www.virtualheartcheck.com.au) offers convenient, affordable CAC screening for adults aged 45+ (males) or 55+ (females) without requiring GP or specialist referral. Read more

EP388: Red Wine, AI, Aspirin, and Time Restricted Eating

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, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode focused on helping Australians understand cardiovascular health and disease prevention. In response to listener feedback, Dr. Bishop structures the episode by previewing, discussing, and summarizing four major health topics: red wine and cancer risk, artificial intelligence in cardiac imaging, low-dose aspirin for colorectal cancer treatment, and time-restricted eating for weight management. Key Takeaways: Alcohol is the third leading preventable cause of cancer, with no safe level of consumption identified; even moderate drinking increases cancer risk despite red wine containing beneficial antioxidants like resveratrol. Artificial intelligence demonstrates higher diagnostic accuracy than expert radiologists in interpreting CT coronary angiography scans, as shown in the PACIFIC-1 trial, and will likely be broadly implemented soon due to improved efficiency and cost-effectiveness. Low-dose aspirin reduces colorectal cancer recurrence by approximately 50% in patients with a specific PI3K mutation, representing a major advancement in personalized, mutation-based cancer treatment with minimal cost. Time-restricted eating (eating within a limited daily window, such as 8 hours) shows good results for weight loss and improved glucose control compared to standard weight loss interventions. The study on time-restricted eating revealed reduced subcutaneous belly fat but unclear results on visceral fat reduction, suggesting 12 weeks may be insufficient to measure visceral fat changes. Combining time-restricted eating with regular exercise and good food choices is recommended for optimal metabolic health and visceral fat reduction. AI technology in radiology will continuously operate without breaks, making it faster and more efficient than human radiologists for high-volume scanning workflows. Future medicine will increasingly incorporate genetic and mutation analysis to provide personalized treatment strategies for cancer and other conditions. Read more

EP387: Obesity, UPF, The Studies, and Sexual Health

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary Introduction Dr. Auric Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode with guest Warwick to discuss three interconnected aspects of obesity and overall wellbeing. The episode examines recent research on ultra-processed foods, weight loss studies, and the relationship between obesity and sexual health. The discussion emphasizes practical, evidence-based strategies for sustainable weight management and metabolic health improvements. Key Takeaways Ultra-processed foods comprise up to 50% or more of modern diets and are strongly associated with obesity and metabolic dysfunction due to their hyper-palatability, which triggers addiction-like brain responses and overconsumption. The high caloric density of ultra-processed foods, combined with chemical additives, preservatives, and excess salt, disrupts the gut microbiome and metabolism, making them particularly problematic compared to whole foods. Most weight loss studies historically fail long-term, with the majority of dieters regaining lost weight within 2-3 years due to the body's metabolic adaptations that resist sustained weight loss. Long-term weight loss success requires high-protein whole foods, resistance training to maintain muscle mass and basal metabolism, and consistent lifestyle habits rather than short-term dieting approaches. The focus should shift from "weight loss" to gradual, sustained "metabolic health changes," including improved insulin sensitivity through fasting and avoiding processed foods found in supermarket aisles. GLP-1A medications (Ozempic, Mounjaro, Wegovy) are changing weight loss treatment but carry the risk of muscle mass loss and require long-term commitment, making them a space requiring careful monitoring. Obesity significantly impairs sexual health through hormonal changes, reduced testosterone levels, insulin resistance, vascular dysfunction, and psychological factors like body image issues and social stigma. Weight loss, particularly fat loss, combined with exercise and dietary improvements, effectively restores sexual function by improving hormone balance, vascular health, and psychological confidence. Policy change rather than education alone is needed to reduce ultra-processed food consumption, as commercial and financial incentives drive their production. Read more

EP386: Dr Foo and Angina Without Blocked Arteries Plus SCAD

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode with guest Dr. Fiona Fu, an interventional cardiologist based in Sydney with expertise in women's cardiovascular health. The episode explores angina and ischemia caused by non-obstructive coronary artery disease—conditions where patients experience chest pain and reduced blood flow to the heart despite having no significant blockages in the major coronary arteries, particularly affecting women. Key Takeaways ANOCA (angina with non-obstructive coronary arteries) and ENOCA (ischemia with non-obstructive coronary arteries) are conditions where narrowing less than 50% in arteries causes chest pain and reduced blood oxygen, traditionally overlooked in favor of diagnosing major artery blockages. The problem occurs at the microvascular (small blood vessel) level, analogous to having clear highways but obstructed small neighborhood streets—the small vessels cannot be visualized on standard angiograms but can be assessed through functional angiography. Coronary microvascular dysfunction and coronary artery spasm are two primary mechanisms of non-obstructive coronary disease, with spasm able to occur in both large and small vessels and potentially causing dramatic vessel narrowing (up to 90%). These conditions predominantly affect women far more frequently than men, though males can also develop them, particularly when there is a family history of coronary artery spasm. Risk factors for non-obstructive coronary disease include high blood pressure, high cholesterol, obesity, and psychological stress—overlapping with general cardiovascular disease risk factors. Coronary microvascular dysfunction is closely linked to heart failure with preserved ejection fraction (a stiff heart), suggesting shared underlying pathophysiology in these conditions. The causes of microvascular dysfunction are multifactorial, including microvascular obstruction, inflammation, and problems with coronary flow reserve, with research still ongoing. Many patients with these conditions are incorrectly dismissed as having no heart problems after normal angiograms, leading to significant frustration, emotional distress, and impaired quality of life. Functional coronary angiograms can now definitively diagnose these conditions through testing vessel function and inducing spasm with acetylcholine, enabling targeted treatment approaches. While outcomes are better than atherosclerotic coronary artery disease, patients with non-obstructive coronary disease still have increased risk of heart attacks and poor cardiac outcomes, making diagnosis and management of risk factors essential. Greater clinical awareness and prioritization of these conditions as a differential diagnosis is needed, particularly given the significant improvement in quality of life and outcomes when properly recognized and treated. Read more

EP385: What You Need to Know About Mono and Poly genics in Lipid Management

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 help Australians understand cardiovascular health. With a heart attack occurring every 20 minutes in Australia, Dr. Bishop focuses on explaining genetics and cholesterol-related issues in simple, clinically relevant terms to help people make informed decisions about their heart health. Key Takeaways: Genetics influence cardiovascular health in two main ways: monogenic (single gene mutations with significant impact) and polygenic (multiple small abnormalities combining to cause problems). Monogenic abnormalities are like brake failure in a car—a single critical failure point—while polygenic issues resemble multiple contributing factors (worn brakes, bald tires, dirty windshield) that collectively cause problems. Familial hypercholesterolemia is a monogenic condition caused by defects in LDL receptor or PCSK9 protein function, resulting in marked elevation of LDL cholesterol that runs clearly in families. Polygenic elevated cholesterol typically produces lower cholesterol levels than monogenic familial hypercholesterolemia and may not show the same strong family linkages or cardiovascular risk patterns. Mixed dyslipidemia (elevated cholesterol and triglycerides together) is predominantly polygenic and often associated with a predisposition toward diabetes. Very high triglyceride levels in isolation tend to be monogenic inherited conditions that can cause serious complications like pancreatitis, while mild-to-moderate elevations are typically polygenic. Lipoprotein(a) is the most genetically significant risk factor for cardiovascular disease and follows a clear monogenic inheritance pattern from family members. Identifying whether lipid disorders are monogenic or polygenic helps clinicians screen families more effectively and sometimes identify specific genes involved in the condition. Read more