EP403: 5 Things That Get Missed on Risk Assessments

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: EP403 - 5 Things That Get Missed on Risk Assessments Introduction Dr. Warwick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode focusing on five overlooked health markers that are critical for cardiovascular health and longevity. While most people focus on cholesterol, weight, and blood pressure, Dr. Bishop explains that these five markers are frequently missed in standard risk assessments but are essential for preventing heart disease in Australia, where someone suffers a heart attack every 20 minutes. Key Takeaways: Coronary artery calcium scoring is the single most effective predictor for cardiac events available, yet it's not used routinely; a zero score indicates very low risk for the next five years and calcium presence indicates plaque buildup in arteries. Calcium scoring is recommended for people 40 years and older, particularly those with intermediate cardiovascular risk, family history, or reluctance about cholesterol-lowering therapy; ideally men 45-50 and women 55-60 should have this as a standard health screening. Insulin resistance measured through the HOMA test (fasting insulin × glucose ÷ 22.5) is crucial because high fasting insulin levels are associated with metabolic syndrome, fatty liver, pre-diabetes, type 2 diabetes, and cardiovascular disease. The triglyceride to HDL ratio is a powerful metabolic health marker; a ratio greater than 2 (mmol/L) or 3.5 (mg/dL) indicates possible insulin resistance, and a ratio less than 1.3 indicates larger, "fluffier" LDL particles which are less harmful than small, dense particles. Lipoprotein(a) [Lp(a)] is "very bad cholesterol" that is stickier and more atherogenic than LDL, can cause heart attacks and strokes even with normal cholesterol levels, and runs in families; it's rarely tested but costs about $65 and remains stable once measured. Waist-to-hip ratio is a critical indicator of visceral fat, the inflammatory fat surrounding organs that's linked to insulin resistance, cardiovascular risk, dementia, and metabolic syndrome; it's essentially a "truth belt" for metabolic health. All five markers together provide comprehensive cardiovascular risk assessment beyond traditional factors, and addressing them involves reducing carbohydrates, exercising regularly, and potentially using resources like Dr. Bishop's weight loss course.