Heart Attacks are Preventable!

EP368: Interview With Candice and What's PEMF Again?

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 Episode Summary Introduction Dr. Warrick Bishop hosts this episode featuring Candice Grove, founder and CEO of Best Self, a company specializing in pulsed electromagnetic field (PEMF) therapy products. Dr. Bishop discovered Candice's work while researching PEMF mats for his wellness center in Hobart and invites her to explain this fascinating but underutilized therapy and its potential health benefits. The episode explores the science behind PEMF therapy and how it works at the cellular level to support overall health and wellness. Key Takeaways: PEMF therapy mimics the body's natural grounding with Earth by utilizing extremely low-frequency electromagnetic fields to stimulate cells to produce their own electromagnetic fields and action potentials. Every cell in the body has an electrical charge maintained by ion pumps in the cell membrane, making humans "electro beings" where electrical signaling is fundamental to all biological processes. Frequencies in PEMF therapy are measured in hertz and should match the body's natural states—slower frequencies (1-4 hertz) for sleep and recovery, while faster frequencies (15-75 hertz) support higher cognitive function and problem-solving. Magnetic field strength is measured in Gauss or Tesla, with therapeutic home devices typically using very low intensity, while high-intensity devices (up to 10,000 Gauss) have been successfully used on racehorses for fracture healing. PEMF therapy promotes blood vessel dilation through nitric oxide production and stimulates mitochondria to produce ATP, which improves circulation and oxygen delivery throughout the body. The therapy reduces inflammation by increasing blood flow to affected areas, enhances nutrient absorption and delivery, and supports bone health by allowing osteoblasts to properly receive electromagnetic signals. Substantial scientific evidence supporting PEMF therapy exists in the Cochrane Review Library, demonstrating that this therapy meets high-level evidence standards despite being relatively unknown in Australia. Candice developed Best Self after years of personal biohacking research and discovering that no one in Australia was offering quality PEMF products, leading her to combine infrared heat with PEMF for enhanced circulation and detoxification benefits. Best Self offers a range of infrared PEMF mats in different sizes and portability options to meet various therapeutic needs, from full-body treatment to portable solutions. A discount code "DR WARRICK" provides $50 off infrared PEMF mats and red light wraps at bestself.com.au. Read more

EP367: 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. Ulrich Bishop hosts this medical podcast discussing cholesterol management and cardiovascular health across diverse patient populations. In this episode, Dr. Bishop covers several specialized topics including ketogenic diets, cholesterol management in women, and treatment considerations for older patients, those with chronic renal disease, and transplant recipients. The discussion focuses on practical clinical decision-making for patient groups that often fall outside standard treatment guidelines. Key Takeaways: Ketogenic and very low-carbohydrate diets can effectively flatten blood sugar levels, reduce appetite, lower blood pressure, improve insulin control, and support weight loss, leading to better overall patient wellbeing. A major concern with ketogenic diets is that they often replace carbohydrates with saturated fats, which significantly raises LDL cholesterol levels, particularly in "hyper responders," potentially offsetting cardiovascular benefits. High LDL particle numbers and elevated LDL cholesterol remain linked to arterial plaque buildup even when particles are large and fluffy, as evidenced by young patients with familial hypercholesterolemia who develop arterial disease. For patients on ketogenic diets with high cardiovascular risk, Dr. Bishop recommends maintaining reduced carbohydrate intake while minimizing saturated fat and pursuing the lowest possible LDL cholesterol targets, pending results from ongoing research trials. Women clearly benefit from statin therapy and non-statin cholesterol-lowering medications for reducing all-cause and cardiovascular mortality, contrary to historical uncertainty. Hormone replacement therapy is considered potentially beneficial for perimenopausal women without clear evidence of increased cardiovascular disease risk, supporting mood and bone health. Cholesterol-lowering medications should be avoided during pregnancy due to lack of safety data, requiring careful planning when young women with familial hypercholesterolemia consider conception. Treatment decisions for older patients should involve individualized risk assessment conversations, particularly in primary prevention settings, rather than automatic age-based cutoffs. Patients with chronic renal disease on dialysis carry very high cardiovascular risk, though statin data is unclear for this population; however, pre-transplant patients warrant cholesterol lowering to protect their vasculature for their upcoming transplant. Transplant recipients across all organ types often require LDL cholesterol lowering therapy, with specialist input needed regarding potential drug interactions between transplant medications and statins. Read more

EP366: LDL is a Remnant or a Waste Product of Lipid Metabolism

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. Oreck Bishop hosts this educational podcast and videocast, where he explains the complex mechanisms of lipid and lipoprotein particle movement throughout the body. The episode focuses on clarifying how these particles primarily function as energy delivery systems, and he also addresses a listener question about AV nodal ablation for atrial fibrillation treatment. Key Takeaways: Lipoprotein particles' main role is to deliver energy sources (triglycerides) to tissues throughout the body, not primarily to transport cholesterol. Dietary fats are absorbed in the gut, bundled into chylomicrons, and transported via the lymph system, where lipoprotein lipase extracts triglycerides for tissue use. LDL cholesterol is a remnant particle created after triglycerides are removed from lipoproteins; it's not directly produced by the liver but rather taken up from circulation. The liver produces VLDL (very low-density lipoprotein) as an energy source to tissues, which undergoes the same process as chylomicrons, leaving LDL remnants in the bloodstream. Statins and bempedoic acid work by blocking HMG-CoA reductase, reducing cholesterol production in cells, which triggers cells to absorb more LDL cholesterol from the bloodstream. Blood test measurements of LDL cholesterol reflect particle cholesterol in circulation only, not the total cholesterol content within individual cells throughout the body. Every tissue in the body has LDL receptors that allow cells to take up cholesterol for synthesis purposes such as repair and hormone formation. AV nodal ablation is an important treatment option for rate control in atrial fibrillation when other treatments have failed, typically accompanied by pacemaker implantation. Read more

EP365: Talking All Things Risk - Primary, Secondary, Continuum and Residual

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary Introduction Dr. Warwick Bishop, a physician with nearly two decades of experience in cardiovascular health, hosts this episode to demystify risk assessment and cholesterol management. The episode explores why lowering cholesterol is emphasized in cardiovascular disease prevention, addressing common misconceptions held by cholesterol skeptics through a pragmatic, evidence-based approach. Dr. Bishop discusses risk across the spectrum of primary prevention, secondary prevention, and the continuum in between, while introducing the concept of residual risk that remains even after cholesterol reduction. Key Takeaways: Secondary prevention (treating patients who have already experienced cardiac events like heart attacks or strokes) has clear evidence of benefit from cholesterol lowering, with no ambiguity about the need for treatment. Primary prevention is more complex because it involves treating heterogeneous populations where some individuals carry high-risk plaques while others don't, potentially treating many to benefit a few. Atherosclerotic cardiovascular disease should be understood as a continuum rather than a binary condition, with imaging techniques enabling early detection of plaque buildup before symptoms appear. One millimole of cholesterol reduction equates to approximately a 20% relative risk reduction of future cardiovascular events, making LDL cholesterol management a significant modifiable risk factor. Residual risk—the remaining cardiovascular risk even after substantial cholesterol lowering—is addressed through managing hypertension, smoking cessation, weight management, diet, exercise, depression, medication adherence, inflammation, clotting factors, diabetes, and triglycerides. LDL cholesterol represents approximately 50% of modifiable cardiovascular risk factors, comparable to how central banks use interest rates as a single powerful lever to influence complex economies. Lipoprotein(a) is an emerging residual risk factor with promising research expected in 2024 that may lead to new treatment approaches beyond standard LDL lowering. In primary prevention, combining traditional risk factor assessment (age, blood pressure, cholesterol, smoking, diabetes) with imaging findings creates a more accurate risk profile than either measure alone. Risk management involves identifying the "weakest link" in an individual's health chain and developing targeted intervention plans rather than applying uniform treatments. Long-term lifetime cardiovascular risk (20-50 years) should be considered rather than focusing solely on five-year risk assessments, justifying early intervention for elevated traditional risk factors even without current imaging evidence of plaque. Read more

EP364: What you need to know about Protein, Supplements, and more

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 hosts this episode featuring returning guest Alistair Horscroft, a multifaceted professional with backgrounds in naturopathy, nutrition, psychology, and entrepreneurship who is currently retraining as a registered nutritionist in Australia. This episode focuses on protein and amino acid supplementation, exploring why protein powder and amino acid powders are important for maintaining strength and health. The discussion emphasizes the distinction between consuming protein and consuming amino acids, and how this understanding can optimize health outcomes. Key Takeaways: Protein deficiency can significantly impact athletic performance, exercise capacity, and cognitive function, as Alistair discovered after years of vegetarian and vegan dieting limited his athletic potential. The standard protein recommendation is approximately one gram per pound of ideal body weight (or 0.5 grams per kilogram), not current body weight—this distinction matters for those aiming to reach a target weight. Proteins are carriers of amino acids, and amino acids are what the body actually uses for building muscles, bones, hormones, enzymes, and neurotransmitters—making amino acid content more important than total protein quantity. Collagen is an incomplete protein lacking tryptophan and sufficient quantities of other essential amino acids, making it less effective as a primary protein supplement despite its popularity for skin health. Sarcopenia (age-related muscle loss) occurs due to insufficient weight-bearing exercise and low protein intake, but can be addressed through resistance training and adequate amino acid consumption. Essential amino acid supplements are more effective than branched-chain amino acids (BCAAs), as essential amino acids contain all BCAAs plus additional necessary amino acids at comparable costs. The "master amino pattern" is an optimized ratio of essential amino acids designed to maximize net nitrogen utilization, achieving 99% absorption efficiency compared to 50% for eggs and 30% for meat. Amino acid supplementation may be particularly beneficial for individuals with compromised gut health or poor nutrient absorption, as pre-broken-down amino acids require less digestive effort than whole proteins. Read more

EP363: Cholesterol Awareness Week Nov 11 to 15

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 Dee Mason hosts the Brekkie show on Joy 949 and welcomes Dr. Warrick Bishop, a practicing cardiologist with over 20 years of specialist experience and creator of the Healthy Heart Network, to discuss Cholesterol Awareness Week. The episode explores why cholesterol, which contributes to nearly one quarter of all deaths in Australia, remains largely undetected and underappreciated as a health priority, despite being a silent killer with no symptoms. Key Takeaways: Cholesterol is a silent killer linked to approximately one quarter of all deaths in Australia, yet it receives far less public awareness and screening initiatives compared to other health conditions like colorectal cancer. Cholesterol is an essential organic molecule present in every cell of the body, necessary for cell integrity, vitamin transport, hormone formation, and digestion—the problem arises when levels become elevated over extended periods. Early screening is critical; people should get a heart risk check starting at ages 20-30, and especially before age 50, rather than waiting until that age to begin conversations about heart health. A calcium score (heart scan) is recommended for men aged 45-50 and women aged 55-60 as a proactive screening tool, costing around $300 and available through the virtualheartcheck.com.au platform without requiring a GP referral. Approximately 20-25% of people experience their first heart problem as a sudden heart attack, with one in six dying immediately—making the case for preventative screening rather than reactive emergency management. High fitness levels and athletic appearance on the outside provide no guarantee of healthy arteries on the inside, as evidenced by cases like Ironman triathlete Dean Mercer and cricketer Shane Warne, both of whom died young from undetected coronary artery disease. Cholesterol elevation and resulting arterial plaque buildup is controllable and even reversible through interventions including cholesterol medication, aspirin, blood pressure management, weight control, exercise, stress reduction, and diabetes management. Everyone should be considered potentially at risk for heart attacks rather than assuming low-risk status, with screening and preventative strategies applied universally rather than only to perceived high-risk groups. Read more

EP362: Patient Lived Experience Atrial Fibrillation and More With Jim Kaveney 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 Episode Summary Introduction Host Warrick Bishop welcomes back Jim Cavaney for part two of their discussion on this podcast and videocast. Jim is a lived experience atrial fibrillation patient who was diagnosed at 38 years old, underwent multiple treatments including ablations and pacemaker implantation, and is now 50 years old in sinus rhythm. He has transformed his medical journey into purpose through his company Unlimited Health for Companies and his book "Unlimited Heart: How to Transform Your Pain into Purpose." Key Takeaways: Jim's atrial fibrillation diagnosis at 38 coincided with starting his first business and his wife leaving her job to care for their two children, creating compounded emotional and financial stress that paradoxically could trigger more AFib episodes. Stress itself can trigger atrial fibrillation, creating a "slippery pole" where the condition drives stress that perpetuates the condition—a difficult emotional conundrum for patients. "Unlimited Heart" is a memoir-business hybrid that explores the battle between heart and mind, drawing on Jim's childhood anxiety struggles to show how mental fortitude built over time enabled him to handle his AFib diagnosis and business challenges. The three critical questions AFib patients should ask their cardiologist are: (1) What is the cause of my AFib? (2) What lifestyle changes could reverse or prevent it? (3) What treatment options are available? Five warning signs of atrial fibrillation include passing out, irregular/elevated heart rate at rest, general feelings of being unwell, and the value of wearable devices like smartwatches for monitoring pulse irregularities. Approximately 30-40% of AFib patients are asymptomatic and unaware they have the condition until discovered incidentally during other medical encounters. Australian AFib guidelines recommend opportunistic pulse checks for all individuals 65 years or older at every medical encounter to detect irregular, erratic, or "irregularly irregular" rhythms. Jim's company Unlimited Health addresses a gap he identified: while patient advocacy organizations provide information about lifestyle modification, they don't provide the systematic framework needed to implement those changes. Unlimited Health integrates diet, exercise, cognitive behavioral therapy, patient education, and community accountability partnerships—recognizing that caregivers often need support as much as patients. Behavior change requires five elements: willingness to change, information, conversion of information to actionable knowledge, accountability mechanisms, and ongoing support from a coach who celebrates successes and helps patients recover from setbacks. Read more

EP361: Patient Lived Experience Atrial Fibrillation and More With Jim Kaveney 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 interviews Jim Caveney from New Hampshire, a young atrial fibrillation (AFib) patient and author of "Unlimited Heart: How to Transform Your Pain into Purpose." Jim, who holds a degree in biology and worked in corporate training for the life sciences industry, was diagnosed with paroxysmal AFib at age 38 while launching his own business—making him an outlier, as AFib typically affects older populations. The episode explores Jim's personal journey with AFib, his medical treatments, and how he transformed his diagnosis into a mission to help others with the condition. Key Takeaways Atrial fibrillation affects approximately 1% of the general population globally, with prevalence expected to double from 6 million to 12 million patients in the U.S. by 2030, making it an increasingly significant public health issue. Jim experienced early AFib symptoms during college rowing (ages 20-22) that he initially attributed to other causes and weren't diagnosed until his condition recurred aggressively at age 38, demonstrating how AFib can present episodically in younger individuals. AFib can result from multiple triggers including stress, alcohol consumption, infection, surgery, and age, with no single clear cause in Jim's case—though family history, business stress, and intensive endurance exercise may have contributed. Tall individuals who engage in high-level endurance exercise like rowing have increased AFib risk, possibly due to inflammation in the atria; this intersection of genetics, exercise, and body morphology is an active area of cardiac research. Medical management typically begins with medications like beta blockers and calcium channel blockers, though individual responses vary significantly; Jim found calcium channel blockers effective while beta blockers caused problematic side effects. Cardiac ablation procedures can be effective but don't guarantee permanent resolution—Jim's ablation led to atrial flutter complications and eventual AFib recurrence, requiring additional interventions including cardioversion. Tacky-Brady syndrome, a rare complication where the heart alternates between rapid and dangerously slow rates with pauses, developed in Jim's case after prolonged persistent AFib, ultimately necessitating pacemaker implantation for safety. Jim has remained AFib-free for five years since 2019 despite having a pacemaker, demonstrating that successful rhythm management combined with appropriate device support can achieve excellent long-term outcomes and quality of life. Read more

EP360: STOP-CA to Stop Statin Bashing

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: Warrick Bishop hosts this episode to discuss an unconventional application of statin therapy—using statins alongside chemotherapy to reduce cardiotoxicity in cancer patients. The episode focuses on the STOP-CA trial, a landmark double-blind, placebo-controlled study examining whether atorvastatin can protect the heart from damage caused by anthracycline chemotherapy in lymphoma patients. Key Takeaways: Anthracycline chemotherapy, used to treat lymphomas, carries a 10-15 fold increased risk of heart failure due to its cardiotoxic effects on cardiac function. The STOP-CA trial (Statins to Prevent CardiotOxicity Associated with Anthracyclines) was designed to test whether atorvastatin could protect cardiac function in patients receiving anthracycline therapy. Study inclusion criteria required participants to have Hodgkin's or non-Hodgkin's lymphoma, be scheduled for anthracycline therapy, and be 18 years or older, with strict exclusion criteria to maintain study integrity. The primary endpoint measured was a reduction in left ventricular ejection fraction of 10% or more (from approximately 60% down to 50%). Results showed compelling protection with the statin group: only 9% of atorvastatin-treated patients experienced significant cardiac dysfunction compared to 20% in the placebo group—more than twice the rate. The statin group demonstrated 2-3 times greater protection against progression to significant left ventricular dysfunction reduction compared to placebo. The protective mechanism is believed to involve statins' anti-inflammatory properties, which may mitigate inflammatory cellular responses triggered by chemotherapy. Cancer patients undergoing chemotherapy should discuss with their treating physicians whether starting or continuing statin therapy could provide cardiac protection. Those already taking statins who require chemotherapy may benefit from continuing statin therapy, pending specialist advice. Read more

EP359: Defining Family History and High Cholesterol

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary Introduction: Dr. Warrick Bishop hosts this educational podcast episode focused on cardiovascular health literacy. In this installment, Dr. Bishop clarifies two critical concepts for patients concerned about heart disease risk: what constitutes significant family history and how to properly understand cholesterol levels. The episode aims to help listeners distinguish between meaningful risk factors and common misconceptions that may unnecessarily worry them. Key Takeaways: Significant family history of cardiovascular disease only applies to first-degree relatives (parents, siblings, or children) who experienced cardiac events at relatively young ages: males at 55 years or younger, or females at 60 years or younger. Cardiovascular events occurring in distant relatives at advanced ages (such as a great-uncle at 90) do not constitute meaningful family risk for the individual being assessed. High cholesterol must be evaluated differently depending on whether an individual has already experienced a cardiac event (secondary prevention) or has not (primary prevention). For secondary prevention patients (those who have had a cardiac event), high cholesterol is defined as LDL cholesterol above 1.4 millimoles per liter, which is lower than previous guidelines of 1.8. In primary prevention, cholesterol categories range from desirable (total cholesterol under 5.2) to very high (total cholesterol over 7.8), with Australian guidelines recommending an LDL target of 2.0 millimoles per liter or less. Cholesterol levels should be understood as a continuum rather than rigid cutoffs; as LDL cholesterol increases, the risk of plaque formation and cardiovascular events increases proportionally. Dr. Bishop uses a car-rusting analogy to explain LDL cholesterol: prolonged exposure to high cholesterol (like salt air) increases plaque buildup over time, similar to rust formation. Lifetime LDL cholesterol exposure is an important concept; keeping cholesterol lower over a person's lifetime reduces cumulative risk of atheroma development. Individual outcomes vary; some people with low cholesterol develop arterial plaque while others with high cholesterol remain plaque-free, highlighting that cholesterol is one of multiple cardiovascular risk factors. Individuals with very high cholesterol levels, particularly those with familial hypercholesterolemia and positive family history, should be treated proactively to prevent future cardiovascular events. Read more