EP217: An Extraordinary Letter

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary Introduction: Dr. Warwick Bishop is a practicing cardiologist and author who advocates for patient education in heart health. In this episode, he discusses an extraordinary letter from a colleague cardiologist that exemplifies why he created the Healthy Heart Network and promotes cardiac CT imaging technology. The letter reveals concerning clinical judgment about managing a 50-year-old patient with elevated cholesterol, which Dr. Bishop uses to highlight important gaps in modern cardiac risk assessment. Key Takeaways: Cardiac CT imaging can reveal that outwardly healthy people may have unhealthy arteries, and conversely, people who appear at high risk may have surprisingly healthy coronary arteries—making it a valuable tool for accurate risk assessment. The cardiologist's dismissal of cardiac CT for a 50-year-old with intermediate risk (approximately 10% risk of event in 10 years) contradicts current Heart Foundation of Australia guidelines, which support cardiac CT imaging for intermediate-risk patients. A normal ECG does not indicate healthy coronary arteries; the two are separate systems, and assuming a normal ECG means no heart disease risk is medically inaccurate and potentially dangerous. Using cholesterol levels alone to predict cardiac risk is insufficient; comprehensive imaging allows doctors to identify actual plaque burden and tailor prevention strategies with greater precision. Prescribing medication with a "take it or leave it" approach represents poor medical practice and a lack of genuine concern for the individual patient's wellbeing and treatment outcomes. Cardiac CT imaging is cost-effective at $300-$660 compared to the potential devastation of a preventable heart attack, making the financial objection in the letter irrational. Risk-enhancers like elevated cholesterol should trigger further investigation in apparently healthy patients, not dismissal of diagnostic testing. Many healthcare professionals lack awareness of or resistance to newer technologies like cardiac CT that could significantly improve patient outcomes in cardiac risk stratification.