Heart Attacks are Preventable!

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

EP378: Keto and Other Tricky Cardiovascular Situations

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 focused on helping people understand cardiovascular health management. In this episode, Dr. Bishop addresses several specialized and less commonly discussed topics in cholesterol and heart health management, including ketogenic diets, cholesterol management in women, and treatment considerations for specific patient populations. Key Takeaways Ketogenic and very low-carbohydrate diets can effectively flatten blood sugar levels, reduce appetite, promote weight loss, lower blood pressure, and improve insulin control, leading to better overall health outcomes and improved mood stability. A major concern with ketogenic diets is that they often involve replacing carbohydrates with saturated fats, which can significantly elevate LDL cholesterol levels—particularly in "hyper responders"—and potentially increase cardiovascular risk despite other positive health improvements. Even though some patients on keto diets show large, fluffy LDL particles (considered less harmful), high LDL particle numbers can still lead to arterial plaque buildup, as evidenced by young people with familial hypercholesterolemia developing plaque despite favorable particle characteristics. Dr. Bishop recommends a cautious approach for high-risk or secondary prevention patients on keto diets: maintain reduced carbohydrate intake but minimize saturated fat consumption and aim for the lowest possible LDL cholesterol targets. Substantial research confirms that women benefit significantly from statin therapy for both all-cause mortality and cardiovascular-related mortality, contrary to historical uncertainty in this area. Women also benefit from non-statin cholesterol-lowering medications, and hormone replacement therapy is considered potentially beneficial for perimenopausal women without increasing cardiovascular disease risk. Pregnant women should avoid cholesterol-lowering medications due to insufficient safety data, requiring careful planning when young women with familial hypercholesterolemia wish to become pregnant. Older populations (beyond age 65-70) represent the highest cardiovascular risk group and are suitable candidates for cholesterol-lowering therapy when patients are willing and in either primary or secondary prevention settings. Chronic renal disease is a very high cardiovascular risk indicator, and while statin use is unclear for dialysis patients, those awaiting transplants should receive cholesterol-lowering therapy to protect their vasculature. Transplant patients (heart, lung, or kidney) generally require specialist-directed LDL cholesterol-lowering therapy, with careful attention to drug interactions between transplant medications and statins that may be metabolized through similar pathways. Read more

EP377: Podcasthon Interview With Adam Weir from Surf Life Saving Australia

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 hosts Adam Weir, CEO of Surf Life Saving Australia, during the Podcastathon—an international charity awareness event. The episode explores the organization's massive impact on coastal safety, highlighting its century-long history and current operations across the country. Key Takeaways: Surf Life Saving Australia operates 315 clubs nationwide with nearly 200,000 members, conducting approximately 10,000 rescues annually and providing 1.6 million volunteer hours worth approximately $6-7 billion to the Australian economy. The organization performs far more than water rescues, including 50,000 first aid treatments yearly for coastal injuries ranging from cuts to cardiac events, with an additional 14 million behind-the-scenes volunteer hours supporting service delivery. Coastal visitation has dramatically increased from 450 million to 700 million annual visits since COVID-19, creating significant service demands while the organization aims to reduce Australia's 150 annual coastal drowning deaths to zero preventable deaths. Surf Life Saving welcomes diverse volunteer roles beyond lifeguard patrols, including administrative, financial, equipment, and drone operator positions, ensuring participation opportunities for people with varying abilities and skill sets. The organization experiences consistent 2-3% annual growth in volunteer numbers despite broader community challenges around volunteer availability, indicating strong resonance with its mission and community values. Unlike traditional emergency services, Surf Life Saving receives limited government funding and relies heavily on community donations and fundraising, with each dollar donated generating approximately $20 in community benefit. The organization is adopting innovative technologies including AI-powered cameras for identifying water hazards, drone surveillance for emergency response, and equipment tracking devices to enhance rescue capabilities. Surf Life Saving is transitioning to evidence-based "high-performance CPR" techniques that optimize chest compression effectiveness and hand recoil, with pilot studies showing significant efficiency improvements after single-day training sessions. Read more

EP376: Dr. Foo and Cardiovascular Risk For Women—Really Important Episode

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 Dr. Fiona Fu, an interventional cardiologist specializing in women's heart health at Sydney Cardiology and Macquarie University. The episode focuses on cardiovascular disease risk factors specific to women, addressing the underrecognized but significant threat that coronary heart disease poses to women's health in Australia. Key Takeaways: Coronary heart disease is the second leading cause of death in women in Australia and kills more women than all cancers combined, yet remains underrecognized by both patients and medical professionals. Several traditional cardiovascular risk factors—including smoking, diabetes, hypertension, and obesity—pose a greater risk to women than to men. Pregnancy complications including gestational hypertension, preeclampsia, eclampsia, gestational diabetes, preterm delivery, and small-for-gestational-age babies are sex-specific risk factors that significantly increase women's future cardiovascular disease risk. Women who experience pregnancy complications should be monitored closely throughout their lives with regular GP check-ups, blood sugar and blood pressure monitoring, and maintenance of healthy lifestyle habits including exercise, healthy weight, and good diet. Autoimmune and inflammatory conditions such as systemic lupus erythematosus (SLE) and rheumatoid arthritis affect women more frequently and substantially increase their risk of early heart attacks and myocardial infarction, sometimes before menopause. The severity of autoimmune disease correlates with cardiovascular risk, and traditional risk factors amplify the danger when combined with autoimmune conditions. Breast cancer treatments, particularly radiation therapy to the left chest, can cause delayed coronary artery disease, while chemotherapy may impair heart function. Early identification and proactive management of cardiovascular disease through regular screening and risk factor control can prevent deaths, as modern medicine can manage identified heart disease effectively. Read more

EP375: What is the Glycocalyx?

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. Rick Bishop hosts this educational podcast episode discussing the glycocalyx, a microscopic protective lining within the endothelium of blood vessels. This often-overlooked layer plays a crucial role in cardiovascular health and may be implicated in the early stages of plaque formation and atherosclerosis development. The episode explores the structure and function of the glycocalyx, how it becomes damaged, and practical recommendations for protecting it. Key Takeaways: The glycocalyx is a thin, microscopic "slippery" protective layer that lines the inside of arteries, comparable to the slime coating on a fish's skin. The glycocalyx protects endothelial cells (which line blood vessels) and helps them produce nitric oxide and maintain strong cell-to-cell connections. When the glycocalyx is damaged or removed, endothelial cells become more exposed to blood contents and more susceptible to wear and tear, potentially initiating plaque formation. Turbulent blood flow at artery branch points and bends creates shear forces that can damage the glycocalyx, while laminar (smooth) flow protects it. The patchy nature of glycocalyx damage at turbulent flow sites may explain why plaque formation in arteries occurs in specific, scattered locations rather than uniformly. The glycocalyx is composed of complex proteins including integrins, immunoglobulins, albumin, and hyaluronic acid that work together to create a protective environment. Currently, there are no established medical treatments for glycocalyx damage, though some proprietary products exist with limited supporting data. Maintaining lower blood pressure (systolic below 110 mmHg when tolerable) reduces turbulent flow and helps protect the glycocalyx from damage. Arterial imaging in primary prevention settings may help identify areas of glycocalyx damage and early plaque formation before cardiovascular events occur. The glycocalyx represents an important emerging area of cardiovascular research that warrants continued scientific investigation and public awareness. Read more