EP73: SAMHRI Meeting - May 10 & 11, 2019

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 practicing cardiologist and passionate educator who believes that informed patients receive the best healthcare. In this episode, he shares key insights and learnings from the South Australian Heart and Medical Research Institute weekend conference (May 10-11), which covered cholesterol management, prevention strategies, peripheral vascular disease, cardiac failure, and heart attack treatment across a broad range of cardiovascular topics. Key Takeaways: PCSK9 inhibitors can safely lower LDL cholesterol to very low levels (around 0.6 mmol/L) in high-risk post-heart attack patients, reducing future cardiac events, with genetic evidence showing no harm even at levels as low as 0.25 mmol/L. Current Australian guidelines recommend LDL cholesterol below 1.8 mmol/L for post-event patients, but emerging research suggests lower targets may be more beneficial. Sodium-glucose transport blockers (SGLT2 inhibitors) are a new drug class that helps diabetics while also providing cardiac failure benefits, but requires careful monitoring to prevent ketoacidosis with normal blood sugar. The REDUCE-IT trial demonstrated that high-dose EPA (fish oil component) significantly benefits patients with high triglycerides over a 10-year period, though the mechanism and patient selection criteria remain not fully understood. Cholesterol crystals within arterial plaque trigger inflammation, and agents like colchicine (historically used for gout) may help reduce this inflammatory response. Lowering LDL cholesterol to very low levels does not cause memory or cognitive problems, as confirmed by the Ebbinghaus study and genetic evidence. Managing patients with atrial fibrillation who require stents is complex and controversial, requiring balance between anticoagulation (for stroke prevention) and antiplatelet therapy (to prevent stent clotting). The Global Leaders Trial showed that Ticagalor as a single agent worked better than standard regimens at 12 months but lost efficacy by 24 months, suggesting potential long-term compliance issues. Cardiac failure treatment involves numerous options including ACE inhibitors, AT2 blockers, spironolactone, beta blockers, SGLT2 inhibitors, and iron infusions, requiring careful individualized management.