Welcome, my name's Dr. Warrick Bishop. I'm a cardiologist, I'm an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol, for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, and welcome to my podcast and videocast station. I really do appreciate you taking the time to tune in and listen. Look, before I go too much further, if you think there's a bit of interference on the line today, it's because I've got the office window wide open because it's hot in my office right at the moment and I need a bit of fresh air and that hissing noise in the background is the sound of the ocean. So forgive me if you think it's familiar of interference. It's actually the soothing sounds of the ocean. some information around a recent conference that i attended and it really centers around heart failure and cholesterol management and these things obviously are pretty important but i thought i'd give you some insight into the sort of information that we get to be exposed to and get to share when we go to these meetings this particular meeting had a number of people on the steering committee to help guide exactly what was going to be discussed. And I know some of those people personally, and they did a fabulous job. So let's jump into it. Our first morning kicked off with implementation of heart failure therapies for people whose hearts aren't working properly. And we had a fabulous speaker over from Canada, a Professor Shelley Ziroff. And Professor Ziroff was... articulate and clear in letting us understand that current guideline therapy for heart failure with reduced ejection fraction that's a heart that doesn't pump properly is absolutely fairly and squarely centered on making sure we give people good beta blockade therapy that we modify the mineralocorticoid system that we consider neprilysin And that we look at SGLT2 blockers. Well, what does all that mean? Well, beta blockers are the medications that dampen down that fight or flight phenomena. And if you think about it, taking that stress out of your blood system so that it's not driving the heart makes perfect sense. The mineralocorticoid system is the system that is within our body. that has evolved to deal with fluid loss, and it leads to us retaining sodium or salt. By retaining sodium or salt, we keep fluid on board within our body. We also trigger that same sympathetic nervous system. So blocking the mineralocorticoid system makes a lot of sense. The neprilysin system happens to be a group of small proteins or peptides that the heart releases when it's under strain. Now remarkably, these peptides are protective and regenerative for the heart. They reduce fluid accumulation, therefore taking load off the heart. They help the heart remodel. They help with reduction of fibrosis, and they lower blood pressure. All these things are positive in terms of looking after the heart. The last of the four pillars of care for patients with cardiac failure, with a heart that doesn't pump properly, is a group of agents called SGLT2 blockers. That stands for sodium, glucose, transport blockers and these agents work predominantly in the kidney to allow sugar to be released when normally it'd be reabsorbed. Now these particular medications started life as diabetic therapy but it became apparent in early trials that these very agents were keeping people with cardiac failure out of hospital with readmissions which really led to an explosion in research in that space. Turns out that the more they looked at these SGLT2 blockers, the more they found out that these agents were actually beneficial for individuals with heart-related problems. So a great journey for this particular group of drugs which started in the diabetic space and now are in the diabetic and fairly and squarely in the cardiological space. So Professor Xeroth really presented this articulately. She really made it very clear that if we're not basing the foundation of our care for heart failure patients with reduced ejection fraction on those four pillars, then we just don't have the right foundation in place. We had Associate Professor John Amarina follow on that talk with heart failure with reduced pumping, reduced ejection fraction and atrial fibrillation. Now this is a really interesting space and some information has come out relatively recently supporting that concept that if we can find people who are at risk of cardiac failure or who have early cardiac failure and develop atrial fibrillation, then there is a clinical indication. to consider trying to address that atrial fibrillation by atrial fibrillation ablation. Now for those who are listening and are not exactly sure what atrial fibrillation is, atrial fibrillation is an irregular beat of the heart and it occurs when the top two chambers of the heart, the right atrium and left atrium, go out of synchronicity. They lose their synchronicity and therefore the efficiency of the pump is reduced. Think of a pre-pumping chamber. And if that's not working properly, the whole pump doesn't work properly. So Associate Professor Amarina presented data from a number of studies called the Cabana Study and the Castle Study, which were very specific studies telling us that if we could keep people in normal rhythm, they would do better in their heart failure journey. Now, of course, that makes a fair bit of sense. But it is a hard thing to do at times, and sometimes we're a bit reluctant to push people with existing comorbidities down a route that would only expose them to more and more intervention and potentially complication. So this group of, this bundle of information, this collection of data, gives us some guidance in that space. A doctor called Josephine Harris then shared some research around heart failure with reduced ejection fraction in specific populations and focused particularly on the elderly and frail. Now often these individuals are not included in the standard randomized trials which inform the way we practice medicine. Registrar days, we were training very similar time at Flinders Medical Centre in South Australia. Dr. Harris was able to share with us snippets of information which really told us that the frail and elderly really do benefit from appropriate therapy and we shouldn't be holding back on our implementation of those four pillars thinking that the old or frail may not benefit. A tremendous opening session for this particular conference and really set the scene for more learning as we took a break for morning tea and then came back to a couple of workshops. I'll share those workshops with you and then I might end this particular podcast and pick up the remainder of this conference in the next podcast. Session that we then came back to after the heart failure session where Professor Zeroth, Associate Professor Amarina and Dr. Harris spoke, was based on a case study which was presented by Dr. Jay Ramanathan. And Dr. Ramanathan told us about a patient who was in his mid-30s who had high cholesterol. who was very adamant he didn't want to take therapy. And the conversation was around how do we deal with this patient and how do we make diagnoses? Well, it was fantastic to have an open room forum where we had... Specialists in the field suggesting that this particular person based on his cholesterol levels almost certainly had familial hypercholesterolemia, which is a family predisposition to very raised cholesterol and bad arteries. But equally, in the same group of specialists, other experts in the field were suggesting that the diet that this patient took And this patient happened to be in his 30s, as I said, but a personal trainer and following a paleo or very, very low carb diet. So therefore a lot of fat in it. Other experts suggesting that the diet, in fact, was driving these changes and that it would be impossible to make a diagnosis of familiar. for this patient. Well, we talked about lots of stuff, things like imaging the arteries, the carotids, and even the heart to try and get as good an understanding as possible of what was going on for this particular patient and therefore how we could best tailor our advice. The interesting thing, though, was that Dr. Ramanathan kept coming back to this patient's real apprehension about taking medication. almost over and above or disproportionate to the reality of potential side effect in that this patient had tried rosuvastatin at an intermediate dose and after two weeks believed he was having side effects when he couldn't hold a yoga pose for as long as usual. He had no pains, simply couldn't hold a yoga pose. So I think... What we got from this study is it's important to try and understand where people are coming from. It's important to try and understand the complexity of diagnosis of familial hypercholesterolemia, particularly in people who are taking a lot of fat in their diet because this can confound the diagnosis, that we can also back up what we know, what's going on with the individual by imaging the arteries and getting the best appreciation of exactly what the process is that's occurring in that person. When this particular workshop broke, the next one was a tremendously interesting workshop that was run around heart failure after chemotherapy. And this was run by an associate professor, Aaron Svedlov, who is expert in the field. He presented a couple of cases which were absolutely fascinating. and really reminded us of how important it is to be aware of the potential toxicities to the heart of some of the commonly used chemotherapeutic agents. We spoke about this in some detail, in particular talking about the surveillance around the time of giving the chemotherapy, but importantly for some of the chemotherapeutic agents, for example anthracyclines. the presence of diminished cardiac function can occur as late as 6 or 12 months after the end of the chemotherapeutic regime. So it's an important situation to be not only monitoring patients while they are on the medication, but also have in place strategies for ongoing surveillance at the end of their, or cessation of their... chemotherapy protocol an absolutely valuable fascinating and important area and one that we have to be reminded of on a regular basis now of course we see through our own rooms patients regularly who are being sent by their oncologists for evaluation but i found that presentations particularly beneficial and particularly important in terms of reminding us and me of a very common and very important clinical situation. One of the other really interesting things was that when they drilled down into the patients who were having side effects from chemotherapeutic agents, there is some Very preliminary work looking at potential genetic markers which could identify these people even before they have a problem. So how exciting is that? Look, I'm going to wrap that up there. The conference was fantastic. The knowledge was just tremendous. I'm going to come back and share in the next podcast. And for now, I'm going to invite you to shoot me any queries or questions if you have any. You can do that at info at drWarrickbishop.online. If you have any ideas for future podcasts, you can drop me a note there as well. Oh, I will add that I'm incredibly excited that I've been dropping in and out of Australia's top 100 medical podcasts lately. So if you've not subscribed... please go to your favorite listening platform, whether that's Spotify or iTunes, and please subscribe. I'd really be grateful. I would love to cement a place in the top 100. And if you think the content is valuable, share it with a friend and ask them to subscribe as well. For now, though, I'm going to wish you the very best. I hope you live as well as possible for as long as possible. Take care and bye for now. Ever wonder what your risk of heart attack is? After all, it is the single biggest killer in the Western world. It accounts for 9 million deaths globally. And the scary thing is it seems to be able to affect anyone. Well, if you're interested in knowing more about your risk and understanding more about precision around that, please check out a free risk check at www.virtualheartcheck.com. dot au.
