Heart Attacks are Preventable!

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

EP384: Will Your HDL Save You?

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, keynote speaker, and CEO of the Healthy Heart Network, hosts this episode to help people understand cardiovascular health. In this episode, Dr. Bishop challenges a common misconception about HDL cholesterol, explaining that having "good" HDL levels alone does not guarantee cardiovascular protection and may not be as beneficial as many patients and doctors believe. Key Takeaways: Cholesterol exists as molecules in cells and also travels through the bloodstream in particles called lipoproteins, which are categorized by their protein types: ApoB (harmful) and ApoA (protective). ApoB particles carry "bad" cholesterol (LDL) and create environments for plaque formation, while ApoA particles carry HDL "good" cholesterol and theoretically transport cholesterol back to the liver through reverse transport. The total cholesterol-to-HDL ratio in many risk calculators may primarily reflect the amount of harmful ApoB cholesterol present rather than revealing any special protective benefits of HDL itself. Research shows a U-shaped curve relationship with HDL levels, where both very low and very high HDL levels are associated with increased cardiovascular risk, indicating the relationship is far more complex than "higher is better." Multiple clinical trials using different agents (niacin, fibrates, CETP inhibitors, and even infused ApoA1) have raised HDL levels but failed to demonstrate reduced cardiovascular disease risk, challenging the protective HDL hypothesis. The primary cardiovascular risk driver appears to be exposure to ApoB particles and their associated cholesterol rather than HDL levels, suggesting doctors should focus on lowering harmful particle count rather than reassuring patients based on HDL alone. Having high HDL cholesterol alone should not provide false confidence; patients should not assume they are protected from heart disease based solely on favorable HDL readings. HDL is an extremely complex molecule and transport mechanism with significant individual variability, making it inappropriate to view it as a simple, one-dimensional "good cholesterol" marker. Read more

EP383: AUSactive Barrie Elvish Interview

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 featuring Barry Elvish, the CEO of AusActive, a not-for-profit industry association representing nearly 3,000 fitness and physical activity businesses across Australia. The episode focuses on the importance of exercise and movement for health, discussing AusActive's mission to get Australians more active and their community activation campaign called "A Million Moves." Key Takeaways: Every 20 minutes someone in Australia suffers a heart attack, with most cases potentially preventable through better understanding of blood pressure, weight, and cholesterol management. AusActive represents over 10,000 fitness professionals and advocates for increased physical activity across all levels of government, emphasizing that finding an enjoyable form of exercise is critical to long-term adherence. The "A Million Moves" campaign is a 21-day community activation program launching in Queensland and Western Australia in September, encouraging participants to complete 75 "moves" daily (which can range from squats to 7.5km walks). The average healthy lifespan for Australians is 10-11 years shorter than total lifespan, meaning many people spend their final years deteriorating; regular exercise is the most effective way to extend healthy lifespan. Exercise reduces cardiovascular disease risk by 30-40%, improves cholesterol profiles, lowers blood pressure, reduces insulin resistance, and can be as effective as first-line antidepressants for mental health. Social connection through exercise is critically important for mental wellbeing and suicide prevention, particularly for older males who lose workplace social networks upon retirement. Barry Elvish personally uses exercise as his primary tool for managing lifelong mental health challenges, combining morning limbering exercises with his wife and 4-5 gym sessions weekly. Exercise provides practical quality-of-life benefits, such as maintaining the physical capability to lift and play with grandchildren, making it valuable both for health outcomes and personal relationships. COVID-19 lockdowns exposed how fitness facilities were undervalued by government policy, being grouped with non-essential services despite serving 8 million Australians over age 15. Read more

EP382: Fantastic Interview With Professor and Caridologist Alan Rozanski Part 2

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, interviews Professor Alan Rozanski—a highly credentialed clinician and researcher with decades of experience—for the second time on his podcast focused on heart health. The episode explores dynamic changes in how heart disease presents and what now drives mortality risk in modern patient populations, revealing a significant shift from traditional markers of disease to lifestyle and physical capacity factors. Key Takeaways: While treatment of identified heart disease has improved dramatically, mortality rates among stress-tested patients have remained flat over recent decades, indicating a fundamental shift in what drives patient risk. The most powerful single risk factor identified in recent data is the inability to exercise on a treadmill, which increases 10-12 year premature mortality risk by threefold. Historical presentation of heart disease has shifted from slim individuals with coronary artery disease showing ischemia (30% in the 1990s, declining to 5% by 2010) to obese individuals with poor exercise capacity and shortness of breath carrying equivalent mortality risk. A simple zero-to-10 self-reported exercise question is highly predictive of long-term mortality outcomes across multiple cardiac imaging modalities and is synergistic with objective test results like calcium scores. Physical deconditioning and musculoskeletal problems are major barriers to exercise that are often underdiagnosed and underaddressed in clinical practice, yet are readily treatable. The 2018 U.S. Physical Activity Guidelines represent a paradigm shift by endorsing that any amount of physical activity, regardless of duration or intensity, provides health benefits—enabling clinicians to move sedentary patients onto the "playing field" rather than focusing only on vigorous exercise targets. Traditional reductionist approaches focusing solely on ischemia miss the "global risk" picture; doctors must report comprehensive risk profiles rather than low-risk determinations based on imaging alone. Lack of physical activity is associated with multiple adverse health outcomes beyond cardiovascular disease, including increased cancer risk, making exercise a universal protective factor for all-cause mortality. Preventative cardiology requires identifying at-risk individuals who may lack clear disease markers at present but have modifiable lifestyle risk factors that will drive future outcomes. Read more

EP381: Fantastic Interview With Professor and Cardiologist Alan Rozanski Part 1

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode featuring Professor Alan Rozanski from Mount Sinai Hospital in New York. The discussion centers on Rozanski's groundbreaking research into the six domains of health and vitality—a comprehensive framework for understanding how physical, emotional, cognitive, social, and stress-management factors work together to promote longevity and prevent heart disease. Key Takeaways: Mental stress can cause acute vasoconstriction and reduced blood flow to the heart in people with coronary disease, a discovery made in the 1980s when Rozanski observed patients' hearts responding to emotional stressors during imaging. The six domains of health are: physical health (exercise, resistance training, diet, sleep), quality of thinking/mindset, emotional well-being, social relationships, sense of life purpose, and stress management. Optimism and positive thinking patterns contribute to longer lifespans and reduced heart disease risk, supported by multiple meta-analyses and decades of research data. Social relationships and social connection are among the strongest predictors of long-term health and longevity, as evidenced by the Harvard Longevity Study and the 1979 Alameda County study. A strong sense of life purpose directly correlates with better health outcomes, making existential meaning-making a critical health domain. Exercise and resistance training should be treated as separate pillars with distinct approaches; resistance training requires proper instruction, progressive overload, and effort, unlike casual physical activity. The focus should shift from acute stress responses in those with existing disease to chronic lifestyle factors that promote vitality and prevent disease development. Early detection methods like calcium scoring and coronary angiography allow for earlier intervention before acute stress becomes problematic for cardiac patients. Read more

EP380: Dr. Har Hari on Healing Through Mitachondria

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 featuring Dr. Hahari Kussler, a holistic chiropractor and founder of the Transformational Healing Universe based in Beverly Hills. The episode explores alternative and integrative healing modalities—including energy medicine, pulsed electromagnetic field therapy, hyperbaric oxygen therapy, and red light therapy—and how they complement conventional Western medicine in addressing the root causes of chronic disease. Key Takeaways Holistic medicine addresses healing on three levels: physical, biochemical, and energetic/psychological, rather than treating symptoms in isolation. The CyberScan system, a German-engineered biofeedback device that measures body energy, has demonstrated over 90% accuracy in identifying underlying health conditions in over 10,000 patient scans. Pulsed electromagnetic field (PEMF) therapy, supported by double-blind randomized controlled trials and Cochrane Review research, can accelerate healing by approximately five times faster than normal recovery. High-powered PEMF therapy (extracorporeal magnetic transduction) enabled 50% of knee replacement surgery candidates to cancel their procedures in a German orthopedic study. Hyperbaric oxygen therapy activates over 8,000 genes responsible for healing and anti-inflammation, and can triple circulating stem cells after one week of daily sessions. Extended hyperbaric therapy (60 dives over three months) can regenerate telomeres by 25%, effectively reversing cellular aging markers. Red light and near-infrared therapy maximize ATP (cellular energy) production in mitochondria, with red light promoting collagen and fat loss while near-infrared penetrates deeper to support organ function and melatonin production. The gold standard for mitochondrial health combines hyperbaric oxygen, pulsed electromagnetic fields, and red light therapy to optimize total cellular respiration and mitochondrial biogenesis. Supplemental support with CoQ10, D-ribose, L-carnitine, and magnesium complements external energy therapies by supporting the electron transfer chain and mitochondrial function. "Stacking" multiple integrative therapies—combining supplementation with energy-based interventions—produces synergistic healing effects greater than any single modality alone. Read more

EP379: Bad Language in Cardiology, Prevention, and 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 is a cardiologist, author, keynote speaker, and CEO of the Healthy Heart Network dedicated to helping people live well for as long as possible. In this episode, Dr. Bishop addresses problematic language and concepts that hinder our understanding of cholesterol and cardiovascular health, aiming to clarify misconceptions that affect how we approach heart disease prevention. Key Takeaways: The term "coronary artery disease" is misleading because it focuses only on the final stage of atherosclerosis rather than the decades-long progressive process, making it harder to identify and treat people with early plaque buildup. Atherosclerosis is a progressive, lifelong condition that develops over years and decades, often silently and asymptomatically, requiring a shift in how we conceptualize and manage cardiovascular risk. Secondary prevention (treating people who have already experienced cardiac or cerebrovascular events) is scientifically proven effective with cholesterol-lowering medications, but primary prevention remains controversial and confusing. The term "low risk" is dangerously misleading because risk calculators typically measure only five-year risk, while people expect to live for decades; this false security can delay necessary monitoring and intervention. Cholesterol as a molecule is essential for human health (membrane integrity, hormone production, digestion, vitamin D formation), but blood cholesterol measurements refer to cholesterol particles carried by proteins, which are fundamentally different. Not all cholesterol particles carry equal cardiovascular risk: chylomicrons and HDL particles (with ApoA1 protein) are not significantly linked to disease risk, while VLDL, IDL, and LDL particles (with ApoB100 protein) are the problematic particles that promote atherosclerosis. The analogy of salt particles near the ocean causing rust on a car illustrates how ApoB particles create an environment for plaque formation—more particles increase risk gradually without a clear safe threshold. "High cholesterol" is an imprecise term that conflates three different risk categories (borderline high, high, and very high), which represent very different clinical pictures and treatment implications. Very high cholesterol requires definitive intervention, while controversy exists about treatment for borderline high and lower cholesterol levels, yet using the umbrella term "high cholesterol" creates dangerous confusion between these groups. Heart disease affects one in four people in Australia and is often preventable with proper understanding; clearer language about cardiovascular risk factors is essential for better prevention and treatment decisions. Read more