Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and welcome to my podcast and videocast station. Today, I'd like to share with you the 10 commandments of good heart health. Let's run through them quickly and then go back to them in more detail. Well, first of all is lifestyle. Top of the list. Second, we're thinking about having a group of people or a team. Support you with your health objectives. 3. Know your risk. 4. Sort out your diet. 5. Exercise. 6. Be on top of diabetes. 7. Don't smoke. 8. Know where aspirin fits. 9. Know when to treat cholesterol. Keep a very close eye on blood pressure. Let's go back and look at each of those in more detail and start off with lifestyle. Well, importantly, sensibly, when you think about it, it makes perfect sense, but you have to start lifestyle early. You can't live for five, six or seven decades and then go on a health kick and expect that you're investment. or lack of investment for the years ahead won't have had an impact. You need to be thinking about lifestyle as soon as you possibly can. Put it in place and start to build on it. Number one is lifestyle. Number two is having a team. That means that not only will you look after your own heart health, but you may engage with your local family doctor. You may engage with a specialist. You may engage with a dietician or an exercise physiologist or perhaps even a social worker because we know that socioeconomic issues can have a big impact on people's cardiovascular health into the future. So think about your team and if they're available there for you, please use them. It's really important you know your risk as well. For adults around the mid-40s through to 75, the recommendations are that you get your risk assessed. And there's risk calculators to help with that. And that's something that your doctor will take you through. This allows the doctor and patient to have specific conversations about what's going on for that individual. Does that person need a blood pressure medication? alter their risk calculator. Do they need a cholesterol agent to alter that risk calculator? Perhaps they need aspirin but you must lock in with your doctor and get that checked on a regular basis. In certain subgroups in the evaluation of risk there's a space for imaging the heart directly and that's called a coronary calcium score and there are situations where that can certainly be beneficial and help guide precision. around decision making. We all know we should eat a healthy diet. There's no question about that. And I get asked all the time, Doc, what should I be eating? Well, it's pretty straightforward. You want plenty of greens. You want some fruit. Nuts are really good. You want to keep your saturated fats down. They're the fats that are associated with animal products. That's easy to remember. Not too many of them. You don't want too many processed foods, salamis, bacons, etc. These are really quite high in saturated fats, but other preservatives, which really we don't think are good. So minimize those. Legumes, which are things like pulses and beans are fantastic, and garlic we know is fantastic as well. Please keep down the refined sugar. You certainly don't get any benefit from consuming. refined sugar or even having sugary drinks. So keep those out of the diet. It's also really important when you think about diet to ensure you're maintaining a healthy weight. If you drift, then the sooner you can get onto that, the sooner you can put in place strategies or changes in lifestyle to bring yourself back. to an acceptable weight. And that might be where the team comes in, where a dietitian may help, your local doctor may help. You may even link up with some friends and make a decision to all lose some weight together through altering calories, perhaps reducing carbohydrate, and perhaps even increasing exercise. So don't go too far if you are overweight. Well, exercise is just fantastic. study done which looks at exercise and all cardiovascular outcomes suggest that it's beneficial. How much to do? Well the recommendation is at least five lots of 30 minutes per week at least moderate maybe walking at a brisk pace. To a large degree though exercise also has to be enjoyable so my own experience is if you're not enjoying your exercise you probably won't do it regularly. So if you can possibly find something that gives you joy and you can exercise, find it, hold on to it and do it. It might be that you have a dog that you can take for a walk because your dog will always be very grateful for the chance for a stroll outside. And it'll keep both of you fit in the longer term. Our sixth commandment is diabetes. And this is a big one. pre-diabetes. Both these conditions really can be significantly managed by lifestyle modification that's particularly diet and exercise. A very clear guided eating habit reducing carbohydrates is so beneficial and regular exercise will burn up the sugars in the bloodstream and both those things will help with weight loss and weight loss is also incredibly valuable in terms of trying to reduce diabetes or reversing diabetes or in people who are pre-diabetic and these are people with sugars drifting up and a bit of weight around the tummy remember i'm talking specifically about type 2 diabetes that diabetes of the elderly diet and lifestyle are absolutely critical and central to the management of that condition and the sooner the better. So please be aware of that. If you're beyond just lifestyle modification, bringing those sugars under control, then most current guidelines would suggest that metformin in the space of cardiovascular disease is probably the next agent to use or the first of the sugar lowering agents. It increases insulin sensitivity and it can sometimes help people lose a little bit of weight. There are a couple of new agents on the market which would follow up and particularly the sodium glucose transport inhibitors have been shown to be beneficial for hearts and these would be a great add-on agent if metformin was inadequate. And there's also the glucagon-like peptide agonists. These things stimulate that peptide and alter the way the body deals with sugar. and favorably improves outcomes for diabetics. Commandment number seven, I'm sure you would have imagined this as pretty close to number one, but it's in at number seven, that's don't smoke. There is no upside to smoking when it comes to cardiovascular disease. If you are hooked on smoking, please do whatever you can to work with someone. to get off the cigarettes it really is a curse that i wish you every strength to get over to overcome for your own best health it does turn out that most people when you look at the averages need about six attempts to quit smoking and maintain it so if you've tried once or twice or three times You've got three more times to try before you're even average at giving up the cigarettes. Please look for support to give that terrible habit for your health up. The eighth commandment is about aspirin and we now have enough data to tell us that we probably don't need to put aspirin in the water generally to reduce risk of heart attack because the risk that aspirin may carry by increasing risks of bleeding is outweighed by the benefit it may offer in the individuals who could potentially have an event. So aspirin is something that you will need to speak with your local doctor or your specialist about. It is very precise in terms of who we need to select for giving aspirin to and these are the higher risk patients, particularly if there's been any imaging that can also help inform that decision. Commandment number nine is know when to treat cholesterol and the sort of guidelines that we see in the Western world these days point to elevated cholesterol as being a flag for consideration of treatment using cholesterol lowering agents. We're talking about cholesterol is over 190 milligrams per deciliter. or over 4.9 millimoles per litre, specifically the so-called bad cholesterol, LDL cholesterol. So this is the sub-fraction we call the bad cholesterol. If that's over 190 milligrams per deciliter or over about 4.9 millimoles per litre, then most guidelines in the world would recommend treating and lowering that cholesterol for the benefit of reduced risk into the future. The agents we use most commonly for that currently are the statins. If you have diabetes there's reasonable evidence to support and most guidelines would recommend that we give you a cholesterol lowering agent and if you've gone through stage number three of the commandments and checked your risk you're between 40 something and 70 something and your score is very high then there may be a role for Treating with a statin or with a cholesterol-lowering agent together with blood pressure therapy plus or minus aspirin, depending on your doctor's advice. The last commandment is blood pressure, and this is so important. It is a hobby horse or a soapbox of mine. Blood pressure is so closely linked to heart attack and stroke, cardiac failure, atrial fibrillation, and renal impairment. We've got to look after it. It's really important to understand, though, that in the first instance, blood pressure ought to be managed with non-pharmacological or non-drug means. And that means weight loss and exercise. Both these things are incredibly powerful at reducing blood pressure. Excessive alcohol consumption can also have an impact. So if you or someone who you care for is drinking too much alcohol and their blood pressure is crept up because of it, Give them a hand to reduce. The take-home message from these 10 commandments is you've got to start early. It's the small investments early on that pay the huge dividends in the longer term. These are cumulative benefits. It's very hard to believe you can leave your life without any attention to these small habits, these... commandments to improve your cardiovascular health and change at the last minute, hoping for a miraculous result. Start early, small steps, look after yourself and avoid coronary artery disease. As always, I wish you the very best. I hope you found today interesting and informative. If you have any queries or questions, please drop us a note at drWarrickbishop.online.com. Thank you so much. I really appreciate you joining me until next time. All the best and goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
