Hi, I'm Warwick Bishop and welcome to my podcast and videocast station. Today I'm delighted to have back Fiona Fu, a general and interventional cardiologist with an interest in women's cardiovascular issues, sports cardiology, climate change and cardiovascular disease. We've already shared one podcast where we spoke extensively about air pollution, particulate matter, emissions and the impact on health. So I'm super excited to pick that up where we were about to talk about traffic and what we can do in the traffic and understand more about it. Fiona, thanks so much for joining me again. Thank you. No, it's always a pleasure. Fiona, we... spoke about emissions. We spoke about bushfires. We spoke about particulate matter and how that gets into the bloodstream. We even touched on microplastics getting into the bloodstream and within arteries. We're not going to dive down that rabbit hole as fascinating as it might be. We're going to start with traffic because that's what we didn't have time for last time. And everyone who's listening to this in any significant size city would have an opinion about traffic. But you tell me a little bit about traffic in the cardiovascular space and pollutant space. Yeah, so I think, again, what's important to know is that, I mean, it's not just heart disease, but traffic-related air pollution is a significant cause of death as well, as well as increasing heart attack mortality, so death from heart attacks. And they did a modelling study which did show that in Australia, traffic-related air pollution probably contributes to more than 11,000 deaths. altogether and more than 12,000 cardiovascular disease hospitalizations. So this was a study that was modeled off a New Zealand study. But essentially, and the problem in Australia is also that traffic, like so personal emissions, traffic emissions are about 10% of Australia's emissions. And it is the fastest growing source of emissions. So they've got bad effects on the health, but they also have bad effects on the environment. So what can you do? So, I mean, ultimately, you know, electric vehicles don't have exhaust, but in the meantime, the other thing is, you know, trying not to travel when you're, you know, when, when there's a lot of traffic. thing we were chatting about, which I think is really important, is something called idle off, which is where people idle their cars, you know, when they're waiting for something. Particularly, and our concern particularly was because we have kids, is that people idle their cars in front of the kids' pickup lines. And they're the worst people to be exposed to traffic-related air pollution because they've got immature lungs. So one of the kind of initiatives that we're trying to kind of get going is something called idle off where people switch their engines off. Every time you stop your car, you should switch your engine off. You know, you shouldn't be leaving your car engine on in front of, you know, in front of a school, in front of anywhere, because it's just wasting petrol, to be honest. And you're, you're, you're causing. other people around you to inhale. So, you know, it's equivalent to like, you know, lighting up a cigarette next to a non-smoker really. So that's one thing. Obviously electric vehicles, you know, you know, don't have emissions. So that would be the other thing. The other thing which I think is important is about active transport. So that will save. a lot of emissions. So active transport is when you walk or cycle to work rather than use your car, but even like using more public transport, so you've got less vehicle emissions in general, and you also have that incidental exercise when you're using public transport, has also been shown to not only reduce air pollution and reduce emissions, but also been shown to reduce cardiovascular disease because of that reduced exposure of traffic-related pollution. Fiona, I'm aware that there are some car manufacturers who already have an idle-off type technology, so it can't be that far away from being broadly utilised. I would imagine that a legislative change by our leaders could actually implement that fairly effectively, fairly quickly, I would have thought. Yeah. And that, and that's, it's interesting. So, so far not in Australia, but in the UK, I think in London, as well as in New York, there are places where you cannot idle your car. So in the cities, there are idle free zones where you, where you can't idle the car. Actually, I was in the, I was at the zoo the other day and they had a big sign where the buses stop and they said, you know, switch your engine off. Yeah. But it's not, it hasn't been like, kind of fully enforced in Australia yet. And, I mean, you know, that's something, you know, we would hope to try to do, but, you know, it takes, I guess it takes a lot of effort to do that. There's just definitely interest in it. In the news, just for fun, it was the person who promoted it was Billy Idol. Yeah, right. Is that right? Yeah. I was going to say, probably it needs a champion, almost certainly needs a champion and almost certainly needs, someone in government who's open to make some changes, but it certainly sounds like a great idea and just common sense. While we were talking about traffic in general, I just wondered if there's a particular culprit. Do we see those diesel vehicles as more of a problem than petrol vehicles? Do we see the trucks that blow out a bit of smoke as greater sinners than... uh a small petrol car is are there still obviously there's more small petrol cars how do is there any way of thinking about those do we see them as different obviously they're different types of yeah i think yeah i yeah to be honest i'm not i'm not i don't know um i know diesel traffic definitely has been shown to be particularly um uh particularly toxic um so so i i and you know presumably the the bigger Big exhaust, you know, this is why the big four-wheel drives and the big trucks, they definitely, you know, pump out more traffic pollution. The other thing to note with traffic-related air pollution is that, you know, we were talking about PM 2.5, they also have ultrafine particles, which are difficult to measure, but they're worse because they go in even more, because they're smaller, they go in even further than the PM 2.5 particles. Okay. Well, look, That's fantastic to cover some of that information around that air pollution, emissions, traffic. But what I was also keen to do, because these two podcasts that you've helped out with are around climate change and environment. I'd like to talk about climate change a little bit. And in particular, sort of the weather extremes and cardiovascular health, hot and cold, I guess. Yeah. So I think, yeah, I think this is the bigger issue. And I think definitely the extreme heat, extreme heat is, as we all know, is increasing and we're getting more and more heat waves. And, you know, heat and heat waves, they're silent killers. In Australia, it kills more people than any other natural disaster combined. And the primary cause of death during a heat wave is from a cardiovascular event. So heat is extreme heat. is an important cause of death, but it's also an important cause of cardiovascular disease, death from cardiovascular disease, but also an important cause of heart attacks as well as strokes, as well as heart failure. as well as arrhythmias, okay? So like a sudden cardiac death and irregular heart rhythms. So it is very important and particularly with heat waves, the greater the intensity of the heat waves, the greater the risk as well. So you've got extreme heat temperatures, but then you've also got prolonged heat waves where you've got high temperatures for several days that it increases cardiovascular disease. The other thing to add in addition to that, apart from just the temperature itself, is the humidity. So like both high and low humidity, but particularly I think high humidity with extreme heat increases your risk of cardiovascular disease death, as well as if you had low green coverage. And then the other thing is with air pollution. So we're talking about bushfires earlier. So if you combine... heat as well as so extreme heat as well as bushfires which is what happens because with extreme heat you're going to get bushfires um then the those effects are what we call synergistic meaning that the the two the the joint effect is greater than the two individual effects and so that's really important to know and you know we're affected a lot in Australia because we've got the summers with you know, extreme heat as well as fires. And then you've got those additive effects on cardiovascular disease, mortality and morbidity. So hospitalisations, yeah. One of those striking figures there, Fiona, was that significant temperature events account for more deaths than any other natural disaster. That's a striking... Yeah, in Australia, yeah. I wouldn't have guessed that. And I guess as you were sharing, I was trying to think, you know, who are the people at risk? Well, of course, some elderly and frail people who are maybe trying to get to the shops. But I know there are also quite a lot of athletes, often athletes who are, for want of a better term, if you're listening, it's not a derogatory label, but there are weekend warriors who go out and really pound the pavement or pedal hard with their lycra on and really try and get a week's worth of exercise on one of their weekend stints. And I just wonder if you've got any insights into the sort of individuals who are greatest at risk during these times. Yeah, so athletes I'll go into in a second, but what you said, so elderly, so it's elderly as well as young. and pregnant ladies, but it's those of underlying chronic disease. So anyone with heart disease, lung disease, renal disease, they all have an increased risk. The other one is mental health. So when it's hot, mental health disorders significantly increase. So admissions with mental health also significantly increase. So they're the ones that are most vulnerable. Also the people who can't afford like the low socioeconomic. you know, who can't afford air conditioning and who can't, you know, who do not have the ability, but these are the vulnerable groups and then outdoor workers are the other big group. Okay. And so then, and then we talk about athletes. So yes, it's those ones who, yeah, maybe weekend warriors, but the other ones are the ones who do like, you know, we're such a sporting nation, you know. Everyone who's doing outdoor sports, like all the individuals, anytime there's an outdoor event and all the outdoor training and it's heat, you know, they're all exposed to that. And there was a paper published about a month ago in the lead up, you know, because Brisbane's getting the Olympics and because the Olympics are going on in Paris. And, you know, they're... there is it's hot in the northern hemisphere at the moment right so that all of these athletes are a significant risk of heat related illness which can be as bad as something called heat stroke which cause you know severe neurological disability and then like death so um so i think it's important because first of all all these sporting places have to recognize these heat related illnesses that they can get when when they're you know when they're training or when they're playing the games and And the organizations also have to have the ability to move them to different times or reschedule as well. And then the other people who are vulnerable are the spectators and the volunteers. So they make the point that, you know, if you're watching a cricket game, because I think there was like a test cricket match in Perth one year and it was significantly hot, like, you know, it was so hot outside and you're watching there for hours, you're in the sun, you know, those people need to be advised about what to do and how to keep themselves cool in those situations. Yeah, so that's important to know that everyone is vulnerable, but some people are more vulnerable. And just because you're young doesn't mean you can't have heat stroke, you can't have any of all these heat-related illnesses, which I think is important for those athletes. For example, the Sydney Marathon that was done last year, they... They started a bit later. They started at maybe I think nine or 10, but, but the temperature was already more than 20 degrees then. Okay. So that meant that there are about seven people that had to be taken to hospital for heat related illness in the Sydney marathon. And so, you know, moving the time to earlier and things like that, as well as having like other things like ice baths, et cetera, and keeping cool during the race is really important. I'm guessing obviously things like hydration as well as keeping cool are outrageously important. Look, just a question from a lack of knowledge in the space. Does keeping hydrated protect you from sort of heat trauma, overheating, this sort of? I mean, I think, yeah, definitely you have to keep, yeah, definitely it's, you know, I think with everyone, we like during heat waves, you know, we, you know, I mean, I tell every patient they should be drinking at least two litres of water a day anyway, and then more in those, in those heat. you know, in those hot, hotter conditions with the, with athletes it's, yeah, it's water, but it's also electrolytes because they'll also lose salt. So you can also have issues with hyponatremia, but, but yeah, definitely lots and lots of water and, you know, more than, you know, more than you're losing kind of thing, essentially keeping cool. So having lots of, you know, cold towels around you. Are we talking about athletes or do you want me to talk about just general? Look, we're just in general. I think we can talk about hypothermia and athletes on another occasion if need be. But as soon as we start talking about heat, keeping hydrated, you and I know that our patients with cardiac failure who are often difficult to get their fluid balances just right, this throws another spanner into the works. And really... really necessitates significant consideration. What's your experience there, Fiona? Yeah, so I think one thing that is recommended, and I think it's important that all our... All these patients, you know, these cardiac patients, I mean, apart from the heart failure patients, you've also got patients on antihypertensives as well. So I think prior to it becoming warmer, I think it is really important to go through medications and also let the patients have a bit of accountability of measuring their blood pressure as well. So if they notice that it's getting a bit too low, you know, touch base and having to reduce it, definitely the diuretic. So like things like Lasix, where they make you lose fluid. They need to be like, you know, looked at and just carefully, like maybe even reduced. But you don't want to take people off their heart failure medications, the other, you know, the other good, the four pillars of, you know, good medications. And you still need to make sure they drink enough, but not drink too much. However, my experience is usually that they actually don't drink much anyway. Like I have a... Well, I have someone who essentially has severe heart failure. She's on all the right medications, but she still has low blood pressure, but she won't drink. Even if you ask her to drink, she won't drink. So she will never reach that 1.5 or whatever restriction that they're on because she actually just won't even drink a liter. You know what I mean? So I think I don't usually have people drinking too much. But yeah, like you're, you know, I'm sure there are people who do, but unless they're kind of critical, critical, I don't think you need to restrict them from drinking. You know what I mean? Like they're not in a, if they're not in acute heart failure, they're not like, you don't need to restrict their fluid intake. Yeah. But you do need to like monitor their, their medications and their blood pressure and just be, I guess, make them aware of what can happen in the heat because they're the ones that are going to be more vulnerable to a cardiovascular event during a heat wave. Certainly, there's no question there can be some real difficulty in not only dealing with these environmental changes, but also patients who are a little bit brittle in their own management of their own medical illness. And I know many years ago, I worked in Darwin as an intern and as a registrar, and it was... common knowledge that during the dry season, during the tourist season, we would be inundated with travellers from down south who'd turn up in cardiac failure. They'd come on their bus trip. They'd been very careful with their fluid consumption, but they also hadn't taken their diuretic, so they wouldn't be inconvenienced on the bus. Yeah, yeah, yeah. But everything, all these moving parts. Anyway, look, I'd really like to finish off on one last critical point, and that's climate change and mental health. Because I think we often talk about, you know, the arteries and we talk about the blood pressure, we talk about the arrhythmias and various other bits and pieces. But at the end of the day, a huge, huge component of our quality of life is our emotional. well-being, our mental health. And I would love you to share some of your own experiences and thoughts around climate change and mental health. And that would be just a wonderful way to wrap this up. So, unfortunately, climate change is a significant, I guess, risk factor for mental health. So, you know, all these extreme weather events have been shown to increase mental health disorders, you know, particularly, you know, depression, anxiety, post-traumatic stress disorder. And then, as we were talking about before, just heat. So heat in itself increases emissions for mental health, worsens people's mental health. uh uh worsens suicide unfortunately um so all these things and then you've also got um the other issue which is um what we call eco-anxiety so people who are particularly worried about the the climate and um uh and have that kind of kind of uh ongoing eco-anxiety about you know the future of our planet so but definitely from a mental health point of view um climate change is a big driver of adverse mental health outcomes And then as you know, mental health is a big risk factor for cardiovascular disease. So, so, so, you know, these are all things like kind of accumulate. And there was also another paper that showed if you combine air pollution, it also worsens mental health and worsens your cardiovascular disease more than in places that don't have air pollution. And then another big one that your listeners probably know about is Takotsubo. So people presenting like, you know, they had a presentation of a. patient who had a, um, had chest pain, who'd lost her flood, her, um, house during a flood. And they're presented with chest pain and had, uh, ST elevation. So, so it was, that looks like she was having a heart attack, but her arteries were normal. And then she had this classic Takotsuba, which is this octopus trap, um, where her heart function, um, wasn't very good. Um, and so, so that's like what we call a stress induced cardiomyopathy such that, um, yeah. And, and, you know, these, these, these kind of stressful events would trigger. So I think climate change is a big, big, big problem for worsening mental health. And then worsened mental health is a big problem for cardiovascular disease as well. So it's kind of all like. Unfortunately, I'm sorry to leave on a slow note, but it is actually quite depressing. It is actually a big problem, yeah, and it's just going to get worse, unfortunately. I don't need to put it lightly, but I guess this is the urgency of why we are talking about this and why we all need to kind of act and do something, yeah. I think it's super important to raise awareness because we're thinking about it in terms of it impacting what we wear, maybe what the weather's like. But this is really important because it's impacting our health on top of that, let alone the sustainability of the planet. But while it's impacting our health, we really should be starting to bring the priority greater and greater because it is more than, you know, we've had a warm summer, isn't that nice? I wonder if it's going to get too hot. It's really going to drive down to how we're going to be able to live on this planet in a sustainable way. and a healthy way, actually. Yeah, that's very true. Yeah. Fiona, it's been an absolute delight sharing with you, really. Again, I know how busy you are as a cardiologist because I am one as well. I know how valuable our time is. I know you spread yourself really thin between cardiology, interventional work, but also family and work outside of that. So, look, thank you once more for sharing today. No, thank you for letting me be part of this. No, as I said, I think it is really important to spread the word and just the knowledge, you know, awareness of all of this is very important. Yeah, thank you. Couldn't agree more. For those who are listening, I'm sure you got as much out of this as I did. Just a fantastic bit of information and such important stuff for us to be thinking about. If you've got any queries or questions, drop us a note at info at drorickbishop.online. If you are listening to this for the first time, I'd love you to subscribe. I found out the other day I'm dropping in and out of the top 100 medical podcasts in Australia. I'd love to drop into the top 50, so if you subscribe, I'd be very grateful. I found I was actually rated number three in Botswana, so I'm due for a trip over there to meet my fans. But now, though, I am 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.
