EP379: Bad Language in Cardiology, Prevention, and Cholesterol

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. Podcast Summary Introduction Dr. Warrick Bishop is a cardiologist, author, keynote speaker, and CEO of the Healthy Heart Network dedicated to helping people live well for as long as possible. In this episode, Dr. Bishop addresses problematic language and concepts that hinder our understanding of cholesterol and cardiovascular health, aiming to clarify misconceptions that affect how we approach heart disease prevention. Key Takeaways: The term "coronary artery disease" is misleading because it focuses only on the final stage of atherosclerosis rather than the decades-long progressive process, making it harder to identify and treat people with early plaque buildup. Atherosclerosis is a progressive, lifelong condition that develops over years and decades, often silently and asymptomatically, requiring a shift in how we conceptualize and manage cardiovascular risk. Secondary prevention (treating people who have already experienced cardiac or cerebrovascular events) is scientifically proven effective with cholesterol-lowering medications, but primary prevention remains controversial and confusing. The term "low risk" is dangerously misleading because risk calculators typically measure only five-year risk, while people expect to live for decades; this false security can delay necessary monitoring and intervention. Cholesterol as a molecule is essential for human health (membrane integrity, hormone production, digestion, vitamin D formation), but blood cholesterol measurements refer to cholesterol particles carried by proteins, which are fundamentally different. Not all cholesterol particles carry equal cardiovascular risk: chylomicrons and HDL particles (with ApoA1 protein) are not significantly linked to disease risk, while VLDL, IDL, and LDL particles (with ApoB100 protein) are the problematic particles that promote atherosclerosis. The analogy of salt particles near the ocean causing rust on a car illustrates how ApoB particles create an environment for plaque formation—more particles increase risk gradually without a clear safe threshold. "High cholesterol" is an imprecise term that conflates three different risk categories (borderline high, high, and very high), which represent very different clinical pictures and treatment implications. Very high cholesterol requires definitive intervention, while controversy exists about treatment for borderline high and lower cholesterol levels, yet using the umbrella term "high cholesterol" creates dangerous confusion between these groups. Heart disease affects one in four people in Australia and is often preventable with proper understanding; clearer language about cardiovascular risk factors is essential for better prevention and treatment decisions.