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. Okay, so there's a couple of things I'm pretty keen to discuss. The first was a study I came across regarding aged black garlic. Now, what is that? Well, basically, if you hold on to garlic for long enough in a nice dry condition, it does go black as far as I'm aware. I think they also call it kyolic garlic. Well, why would you do that? The reason is by... aging garlic you increase some of the compounds within it and one of those compounds in particular is a compound called S-A-L-L-cysteine or S-A-C-SAC for short and we can call aged black garlic ABG for short. Now a group of Spanish researchers took about 67 men who didn't have any major medical condition. They didn't have coronary disease. And these men were randomized to placebo or ABG plus SAC or placebo. And they swapped these individuals over as far as I could tell. So they started off with six weeks of treatment or placebo. had a three-week washout, and then the groups were swapped over to what they were not in the previous time. They gave the participants of the study 250 milligrams of aged black garlic, which equated to about 1.25 milligrams of SAC. That S-L-cysteine is considered a supplement. or a compound that can be beneficial for heart health, vascular reactivity, etc. Now, the interesting thing about this study is they ran it for, well, those two six-week periods with a three-week washout in between, and measured in particular blood pressure, which is what they were most interested in. It turns out that the aged black garlic didn't make much of a difference to cholesterol levels. and didn't really alter any other cardiovascular risk parameters in particular. But what it did do is it seemed to drop diastolic blood pressure on average by about 6 mmHg. And dropping diastolic blood pressure by about 6 mmHg is really quite significant. When we look at the impact of blood pressure and think about the impact of blood pressure, because really... It's the blood pressure that drives the wear and tear within our arteries. When we think about that reduction in the wear and tear on the arteries, that actually correlates to what we have plotted out as the rates of event attributable to different pressures. So a reduction of about 5%, sorry, a reduction of about 5 millimetres of mercury. will reduce risk of stroke by approximately 40%. This is enormous. And risk of coronary vascular disease or heart attack by 30%. So this aged black garlic SAC intervention is really quite powerful if we look at it in terms of that blood pressure lowering effect. What the researchers pointed out is that the results were not too dissimilar to what we've seen in the DASH diet and some of the other dietary interventions. So it is about changing things around. And what I found really interesting was that the reason for aging the garlic was to increase the concentration of these valuable compounds within the garlic and really to a large degree. it gives you some reassurance that enjoying some garlic in with your onions on a regular basis as i tend to do is probably not a bad idea i'm not up for aged black garlic myself but i suspect there may be people out there within the group listening who have enjoyed aged black garlic and take it for their own particular supplemental reasons or you may know of people who have enjoyed taking that as a supplement and have good reason to do so anyway i'm going to continue enjoying my garlic with my onions that i often throw in with a salad the next thing i was pretty keen to talk about was smart devices and it's really topical because just today i've had sent to me a new device which i'm going to be in the process of testing i'm not going to talk about the device i've just received in the mail today because i haven't even charged it but i'm really excited to check it out and the reason is we're seeing more and more studies around these devices that people wear and outcomes with them now there's been a fitbit heart study and there's been an apple heart study well this one that's just come out recently is the mobile atrial fibrillation application Study number two. And this was done through, or was done in China, and they surveyed over 2 million people. They put devices on over 2 million people. It turned out that they found that these devices, which were using photoplasmography, which is a light sensor to check or assess the pulse. I'll say that again. It's a hard one to say. So we often call it PPG to evaluate the pulse, the intensity of the pulse and the shape of the pulse. Very clever. It looks at the rise and fall of that pulse and can assess the regularity or irregularity, if you like, of blood flow. And therefore it can be really helpful for ascertaining if someone's got atrial fibrillation, which is an irregularly irregular rhythm. Well, it turned out that over a four-year period, the mobile AFA study detected 0.4% of atrial fibrillation in the participants, which were a relatively low risk group over that four-year period, certainly demonstrating that it was able to detect and... they figured that there was a pickup of about 93% of possible atrial fibrillation detected. So pretty effective in what it was doing. Remember, this was a low-risk population. But think of, if we can get these devices on people who are low-risk and they wear them over the next few decades, they will, by virtue of age, move into a high-risk category. They use special algorithms for assessing the PPG, photoplethismography to assess the quality and character of the pulse. These special algorithms are really very clever and they've also been able to develop algorithms on these watches that allow an assessment of whether there is possible obstructive sleep apnea. Now they set up an algorithm to assess obstructive sleep apnea. they looked at over 900 000 people and detected osa obstructive sleep apnea in approximately 18 000 people there's no question that the future is going to look something like that where we are wearing devices from a moment to moment basis and the really exciting thing about the device that i've got is i know it links back up with the central monitoring system which is a comprehensive data collection and summary page which allows a very easy feedback and a very powerful tool for insights into what's going on remembering that the device that i'm hoping to be checking out when i open my mail today will not only be looking at ppg pulse and af algorithm but also be looking at temperature, respiratory rate, obstructive sleep apnea, hypertension, a whole myriad of tracking information that can be valuable on a minute to minute basis. So keep an eye out for watches and apps to monitor our health into the future. I think it's really exciting. I want to tell you about... a hypertension trial which has really got my interest it's called the spiral hypertension on trial it's about a process called renal artery denervation where we literally put wires into the renal arteries and through those wires through those catheters we ablate the sympathetic nerves that run along those arteries so that the sympathetic nervous system that can cause vasoconstriction is, if you like, removed from its impact on the kidneys. And the work around this was first done in Australia by a professor called Murray Esler, who is an absolute legend in the world of high blood pressure. Anyway, it's been evolving over years. renal artery denervation the spiral hypertension on trial just released its three-year results three years on from the intervention and remarkably the effect of that intervention has been maintained and held which is incredibly exciting now when we think about The people who go for this sort of procedure, they're generally the individuals who have high, difficult to control blood pressure with multiple therapies already. So the effect at three years was very close to what they saw soon after the intervention in the order of a 10 millimeter systolic and five millimeter diastolic blood pressure reduction. And remember I said to you before, that these sort of reductions will lead to massive reductions on a population basis in regard to risk of stroke and heart attack. 30 and 40% plus respectively, which is huge. Now, the trial didn't really show a reduction in medications because these people already were refractory and had really high blood pressure, terrible to control. And so... What ended up happening was that people still remained on lots of pharmacy, polypharmacy, if you like, or multiple drugs. But they had better control. And at the end of the day, I think people don't mind taking drugs if they're well tolerated and they're effective. And if you could put in this procedure to ensure that it was complementary to the drug therapy, I think most people would receive that very well. Interestingly, because this trial uses a major procedure to control the blood pressure, they did a sham arm of the study. So the placebo group didn't just get nothing. The placebo group actually went to theatre and had someone stick something in their leg and go through what looked like the whole procedure so that they had that. potential powerful placebo effect if you like given to that patient and so these results are over and above just the placebo effect and that placebo effect was replicated if you like by the sham procedure Although this is not currently available broadly and it's not easy to get in Tasmania where I reside, I think we will see this technology come and there will be a time where it becomes more available and there is the opportunity to literally access a Medicare rebate. find selected patients who will benefit from this fantastic technology look one of the other things i want to share with you and the last thing is not a lunar landing but i'm going to talk about the apollo trial and it's interesting because it's in a space of cholesterol lowering where i have a particular interest well the apollo trial came out recently it only looked at 30 odd people 32 people and what it did was look at a small interfering RNA now we know a bit about RNA vaccines because we know about the Pfizer and Moderna vaccine well we're now looking at therapeutic agents that can muck around if you like with RNA or mRNA well the Apollo trial looked at a small interfering RNA intervention to lower so-called lipoprotein little a now you may have heard of lipoprotein little a it's a an ldl like particle a low density lipoprotein like particle with a nasty tail on the end and we think that extra tail can make it more atherogenic it can make it more inflammatory we can make it can make it more pro coagulant and we see elevated LP associated with premature coronary artery disease and aortic stenosis. Well, the Apollo trial was really to assess the efficacy of this siRNA in otherwise well people to evaluate the LP lowering capacity. Well, the trial showed without question it was effective with nearly a 98% lowering of LP little a that's nearly obliterating this protein particle this lipoprotein particle all together and a nice trade-off as well or a nice extra spin-off was that they saw approximately 25% lowering of LDL cholesterol so an incredibly interesting space to watch the agent is called S It's a small interfering RNA. And the Apollo trial, breaking news. It looks like we will have agents to target this particular sub-fraction of LDL particle. 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.
