EP417: Cholesterol—Separating Fats from Fiction

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: Cholesterol—Separating Fats from Fiction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode to promote his new book Cholesterol Explained, co-authored with Karam Kostner and Penny Edmond. The episode aims to demystify cholesterol by explaining the difference between cholesterol as a molecule and cholesterol measured in blood tests, and to clarify common misconceptions about "good" and "bad" cholesterol in the context of heart disease prevention. Key Takeaways: Cholesterol is essential for the body and serves critical functions including building cell membranes, producing sex hormones, synthesizing vitamin D, and creating bile acids. What we measure in blood tests are lipoproteins (particles carrying cholesterol), not cholesterol itself, since cholesterol is a fat that would separate in blood without a protein carrier. LDL and HDL cholesterol are not simply "bad" and "good"—high LDL doesn't always correlate with plaque buildup, and high HDL doesn't always provide protection. Triglyceride levels are more important than previously believed, often indicating insulin resistance and poor metabolic health, and the triglyceride-to-HDL ratio is a powerful metabolic marker. Lipoprotein(a) is a genetically determined particle with very high affinity for coronary arteries and is strongly linked to premature heart disease. Imaging arteries to detect actual plaque buildup is crucial for risk assessment, as individuals can have perfect cholesterol numbers but significant arterial calcification. Statins are neither inherently good nor bad; their appropriateness depends on finding the right individual with actual arterial disease, similar to how Panadol works only for those with headaches. Predicting cardiovascular risk requires a comprehensive approach beyond blood tests, including inflammation levels, insulin resistance, blood pressure, lifestyle choices, and family history.