Heart Attacks are Preventable!

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

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