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. I'd like to take some time to talk about risk factors and specifically risk factors that sometimes fly under the radar. We're all familiar with cholesterol levels, smoking, age, blood pressure as risk factors. And we know that carrying extra weight and poor exercise are important. But let me touch on a couple of things that are Pretty important, and the first of those is a thing called lipoprotein little a, and I think we're going to see more and more of this in the coming years. When we think about cholesterol, we think of a cholesterol profile that has good cholesterol, the so-called HDL, bad cholesterol, the so-called LDL, the one that really tends to deposit cholesterol in the arteries. And the ugly cholesterol, which is triglycerides. And these are really reflective of people who have prediabetes or insulin resistance, who are drinking too much alcohol, who are eating too many carbohydrates, who are overweight, and who are not exercising. Lipoprotein little a is really a bad, bad cholesterol. It's, if you like, very closely related to low density. lipoprotein or LDL cholesterol, the so-called bad cholesterol, but lipoprotein little a has a special tail on it and that protein tail has a sting. It seems to be linked to increased inflammation. It also seems to increase the likelihood of clot formation. So it means it can increase the chance of clots forming within the bloodstream and that's part of the process of heart attack. So this particular subfraction of cholesterol transport, lipoprotein little A, carries with it increased risk of cardiac event. And we tend to see it disproportionately in patients who have heart attack or similar events at an early age. It does vary between ethnicity. It does tend to be... passed on through families. It is important because we are moving towards a situation where we will have the means and mechanism to broadly test it. We can test it at the moment but there is quite a bit of cost behind that or at least an out-of-pocket cost. It's about $50 or $60 which I guess if you're proactive about wanting to know if you're at risk and you've got a family history with premature coronary artery disease it may not be a bad thing to check. But I think in the next couple of years, we're likely to see a Medicare rebate for this testing, which will make it accessible to everyone. And that's going to be driven by the fact that we're seeing on the horizon therapeutic interventions which can target this particular lipoprotein abnormality and lower it. So we know that we can see greater buildup of plaque with lipoprotein little a, greater thrombosis. i.e. increased risk of clotting and inflammation. And we think it's a really important component or one of the risk factors that we really should be thinking about in families where there's premature coronary artery disease. Well, one of the things we hear about regularly is this concept of inflammation. And there have been a number of trials specifically looking at inflammation and its impact. on cardiovascular health. And there's a doctor who has led the charge in investigating inflammation, Dr. Paul Ridker, who's been behind these major trials called Jupiter and Cantos, which have demonstrated unequivocally that there is a component of elevation inflammation in the process of coronary artery disease. Interestingly, I was able to attend a presentation by Paul Rydke recently, and he still maintained that even though inflammation is important, his main therapeutic goal and strategy is to drive cholesterol levels down. As the bang for the buck, getting cholesterol levels really low is greater than trying to treat or modify inflammation of its own. Medications used in the Cantostrol to lower inflammation was a thing called canakinumab. This is a very clever antibody-driven medication, a biological agent that neutralized one of the inflammatory compounds. Problem is, this particular medication is about $100,000 per year. One of the more enticing inflammation studies looked at using a drug called colchicine, one that we've used for many years for gout. And we've used this agent to try and dampen down the inflammatory process of gout. Well, interestingly, in a couple of trials, colchicine appears to have been beneficial in reducing risk of heart attack in the appropriate patient cohort. I think this is going to be a space that we'll see more and more work done in. There's no question inflammation is important. And Dr. Ritka is involved in a trial looking specifically at interleukin-6, one of the inflammatory modulators, and an agent called Ziltivecumab, which is directed specifically at that interleukin, that inflammatory compound. And we will see. outcome data in that in the next few years to come. What can you do to keep your inflammation down? Look after your gut microbiome. Look after your diet. Get some exercise in. Get in good sleep as well. Incredibly important. And that sleep is a lovely segue into our next risk factor, which is obstructive sleep apnea. We know that obstructive sleep apnea is a big problem, and for people who don't breathe properly overnight, they will drive inflammation. They'll drive endothelial dysfunction, which means that their blood vessels will misbehave through the stress and the strain that the lack of oxygen overnight puts on them. And one of the things that is also driven is the sympathetic nervous system. That's the fight and flight nervous system. So obstructive sleep apnea, spending your evenings with inflammation, dysfunctional blood vessels, and a heightened sympathetic nervous system will drive high blood pressure. and atrial fibrillation, and all the consequences of that into the longer term. So if you think you're at risk of obstructive sleep apnea, please go and talk to your GP, get some testing done. An easy thing to do is overnight oxygen saturations, and then from there we can organise appropriate further studies as appropriate. But ask the question, particularly if someone you love... doesn't wish to sleep in the same room because you snore so much, your partner may be the very person to report breathing that stops intermittently or sounds obstructed from snoring. We certainly know that there's also cardiovascular risk disparities based upon socio, environmental and financial factors. And this is really important. We know that well-educated, socioeconomically sound people have access to the best health care and therefore have the best health outcomes. We've got to remember that people who are socioeconomically deprived, who have an environment which is not ideal or are financially challenged, just may not have the resource to deal with the standard cardiovascular risks that... Others who have better resources are able to do. I'm going to touch on diet briefly because if we are talking about cardiovascular risk, we put in things like cholesterol, blood pressure, exercise, smoking history, etc. But rarely do we put in a comment about diet on the standard risk calculators. I think we know that there's good evidence from particularly the PREDIMED study that extra virgin olive oil... together with nuts, are beneficial in terms of reduction of cardiovascular risk. There's no question we need to minimise processed meats, we need to minimise sugars, we need to minimise salt and definitely avoid trans fats. So fruits, limited, veggies, lots, green, nuts, extra virgin olive oil should be the basis of what we're doing. From a dietary perspective, cheese, eggs and unprocessed meat and particularly grass-fed beef and grass-fed other protein sources are preferable. Well, there's a bit of a run through lipoprotein, little eh? Get it checked if there's premature coronary artery disease in your family. A touch on inflammation, which pops up all the time. A reminder about sleep apnea. Not forgetting socioeconomic disparity and a few words on diet. Well, I hope that all makes a bit of sense to you. There are nice reminders about things that we can do and be aware of in our journey for the best health possible. If you've got any queries or questions, drop me a note. Or if you've got suggestions for future episodes, please get in touch at info at drWarrickbishop.online. For now, however, till next time. I hope you live as well as possible for as long as possible. Take care and bye for now. 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.
