The Naked Heart

Grip strength measurement reveals cardiovascular risk more accurately than traditional markers by reflecting muscle function as endocrine organ. Declining strength drives coronary disease through inflammatory pathways. Progressive resistance training provides powerful cardiovascular protection.

When a patient arrives breathless and unable to climb a hill, the instinct is to blame the heart. Sometimes the answer lies in the blood itself. Iron deficiency anaemia reduces oxygen delivery, forces the heart into a hyperdynamic state, and can even produce a murmur over a completely normal valve.Read blog

What if the heart works like a hybrid engine? Continuously switching between fatty acids, glucose, and ketones, it optimises fuel use for efficiency and demand. But in metabolic disease, this flexibility is lost. The result: poorer fuel, narrowed supply lines, and a strained engine — a new way to understand cardiovascular risk.Read the full blogNaked Heart Podcast series

This N-of-1 article explores a simple hypothesis: erectile dysfunction in many men may reflect reversible metabolic disruption driven by visceral fat rather than fixed arterial disease. By tracking waist reduction and symptoms over time, individuals can test whether improving metabolic health restores endothelial function, drug response, and erectile reliability.Read bloghttps://feeds.transistor.fm/the-naked-heart

Groundbreaking research from Oxford University reveals it is possible to detect and quantify ‘coronary inflammation’ – invisible to the human eye on conventional CT images, but detectable using artificial intelligence techniques.Read story

Coronary heart disease often presents without warning, making early prevention essential. This article outlines a personalised approach to identifying individual risk, detecting underlying coronary inflammation and plaque, and implementing structured preventive strategies. Combining risk scoring, advanced imaging and holistic management, we help patients reduce the likelihood of future heart events.To read more see blog

N-of-1 medicine shifts the focus from population averages to personal biology. This blog series explores how individuals with curiosity can run simple, safe self-experiments — using themselves as the control — to test plausible health hypotheses, track meaningful outcomes, and discover what genuinely improves their own health and wellbeing over time.To view the blogTo see Naked Heart Podcast series

HIIT interrupts this cycle by dramatically improving insulin sensitivity and glucose uptake in skeletal muscle — particularly in the large lower-limb muscles of the thighs and glutes. A single 20-minute session of HIIT can activate GLUT-4 transporters in muscle cells for up to 24–48 hours, drawing glucose out of the bloodstream and away from storage in the liver and visceral fat depots.Read full blog ********NOTICE***********This is the last blog in Naked Heart Series for a year. Weekly blogs are to be released on Metabolic Health instead with a view to book launch in 2026 'The VAT Trap'. Sign up to the new Metabolic Health newsletter to stay informedTo view the blog To see Naked Heart Podcast series 

Mitochondria are the power stations inside every cell, converting food into energy. But in modern life, with constant carbohydrate intake and low energy demand, they become overwhelmed. Just like solar panels producing too much electricity for full batteries, mitochondria have nowhere to send surplus fuel. This triggers oxidative stress, inflammation, and early ageing. Insulin is meant to divert excess glucose to safe storage — but when that system fails, metabolic chaos follows. In this article, we explore how your mitochondria manage energy, what causes them to overload, and how lifestyle changes can help restore balance and protect long-term health Full story see blog

Troponin-negative chest pain presentations are often sent home without a timely work up or prompt imaging tests like a CT angiogram.  A delay can be critical. As clinicians, we must identify which patients need further testing urgently. Where clinical suspicion is high, irrespective of troponin rise doctors and health commissioners should prioritise resources, so that an accurate diagnosis can to be made. Lives literally depend on a prompt anatomic test being done in time. Until this has been made available nationally, patients experiencing unexplained chest symptoms who have not had clinical follow up and diagnosis confirmed are advised to 'vote with their feet'- either head back into hospital in event of further symptoms, or even consider arranging to fund their own urgent CT angiogram from an independent medical provider. Read full blog

Before birth, the foramen ovale is a vital foetal opening between the right and left atria, allowing oxygen-rich placental blood to bypass the inactive lungs. After the first breath, pressure in the left atrium increases, closing the flap naturally. In around 25% of adults, the flap does not seal fully — this persistent communication is called a Patent Foramen Ovale (PFO) which is an important cause of cryptogenic stroke. All standard tests including an echocardiogram can be normal- it can be only be diagnosed using a bubble contrast study and once diagnosed, treatment with clam shell closure is high effective. Read full blog

If you have ever found yourself feeling breathless climbing stairs or walking uphill — even though your lung and heart tests are “normal” — you are not alone. Many people attribute it to age or fitness. But recent research has uncovered a powerful hidden cause of breathlessness: visceral fat — the fat stored deep inside your abdomen, around your organs. In this blog, we will explore what visceral fat is, how it affects your breathing, and — most importantly — what you can do about it.  Read full article

“For every threat that rises against us, humanity answers with a greater invention. Show us the enemy, and we will forge the remedy.” For much of modern cardiology, in its battle against coronary artery disease—one of mankind’s greatest threats—the “enemy” seemed clear. When I trained, the diagnostic armoury was focused on accurately identifying flow-limiting narrowing of one or more coronary arteries: the 3–4 mm vessels supplying the heart with oxygenated blood. Prognosis was measured by the number of occluded arteries, the degree of stenosis, left ventricular ejection fraction, blood pressure, and cholesterol profile. Diabetes mellitus was acknowledged as a risk factor, but it was largely regarded as a separate, niche condition—managed primarily by GPs and endocrinologists. Invasive coronary angiography was the gold standard, the reference point against which all non-invasive tests—such as the stress ECG or nuclear cardiology scans—were judged. A patient’s future could be read from the arteries illuminated on that cath lab screen: a narrowing meant risk; an occlusion demanded action. Yet in the last decade, a profound paradigm shift has unsettled these foundations—and in some respects, turned them on their head.

How an ILR Works An ILR is a matchstick-sized device implanted under the skin of the chest, usually under local anaesthetic in a brief outpatient procedure. Once in place, it continuously monitors the heart’s electrical activity, storing recordings of any abnormal events it detects automatically or when triggered by the patient using a handheld activator. Modern ILRs have: Automatic arrhythmia detection algorithms Wireless home monitoring (transmitting daily summaries to the cardiology team) Battery life of 2–4 years MRI-compatibility in most cases When to Consider an ILR An ILR may be recommended if you: Have unexplained syncope with inconclusive standard tests Have had a cryptogenic stroke, TIA, or TGA, where AF is suspected but not proven Have infrequent but concerning palpitations that evade short-term monitoring Have suspected intermittent AV block or sinus pauses   Full blog article 

In the evolving world of preventative healthcare, one size no longer fits all. We are learning that each person has a unique biological blueprint – shaped by their DNA, lifestyle, and environment – which determines how they respond to food, exercise, and medications. Today, sophisticated tools allow us to uncover this blueprint and personalise health advice in a way never before possible. The goal? Not just to avoid disease, but to extend your healthspan – the number of years you live in good health. See full article

Dietary fats have been wrongly maligned for much of modern nutritional history. But as the science evolves, it's clear that fat – far from being harmful – is a vital macronutrient that supports energy metabolism, hormonal health, brain and heart function, and even weight control. Rather than fearing fat, we should focus on: Avoiding refined carbohydrates and ultra-processed foods. Prioritising whole food sources of fat, including nuts, seeds, dairy, eggs, fish, and healthy oils. Understanding individual needs, especially in those with insulin resistance or carbohydrate sensitivity. Viewing nutrition in context, rather than isolating single nutrients as heroes or villains. The time has come to move beyond fat-phobia and embrace a more nuanced, evidence-based approach to eating. In a balanced, whole-food diet, fat is not the problem — it’s part of the solution. Read the full article

As we age — particularly if we have inherited genes that predispose us to metabolic disarray that accompanies modern diet and lifestyles, we start to gain weight as visceral fat increases, and muscle mass declines. This double effect worsens blood pressure, cholesterol triglycerides, and blood sugar — contributing to what is known as the metabolic syndrome. Fat cells that have reached their capacity to store extra energy as a healthy reserve start to cause havoc by releasing free fatty acids and in turn worsens insulin resistance, that steepens the decline in health. However in many cases if we can reduce visceral fat, rebuild muscle, and reach a caloric deficit, we can reverse many of these effects. Read the blog

In the UK, the recommended minimum daily protein intake is 0.75g per kilogram of body weight. However, mounting evidence suggests that this baseline is not enough, especially for older adults, those managing chronic conditions, or anyone engaging in weight loss strategies. In practice, most people are falling short of even this modest target. In this article and podcast, strategies to maintain skeletal muscle mass to improve metabolic health and reduce the risk of sarcopenia are aired. Could equipping our patients attending our holistic GLP-1 mimetic clinic with a food analysis app called Dr Shape and other items in our metabolic toolbox really be the answer? Read the blog article here

Emerging evidence shows that lifetime exposure to LDL cholesterol and high glucose variability are some of the strongest predictors of cardiovascular risk. Just as lung cancer risk is tied to pack-years of smoking, heart disease risk correlates with cumulative LDL levels and impaired glucose metrics  over time. This is why some people in their 20s with risk factors (like diabetes or a family history of heart disease) are starting statin therapy preventatively. However, many are understandably hesitant to start medication so early. Lifestyle changes remain the cornerstone of early prevention. Read the full article with references

It may seem unusual to talk about heart disease in teenagers and children, but the groundwork for heart health is laid early in life. Habits formed in youth often carry into adulthood, and many cardiovascular risk factors—like high cholesterol, high blood pressure, or obesity—can be silent, slowly progressing without symptoms. In families where heart disease runs deep, understanding risk and prevention from a young age can be life-changing. Read the full blog

Cardiovascular disease often strikes decades before symptoms appear, especially in the critical age range known as *"Sniper’s Alley"* (40–60 years). Waiting until 60 is too late. Early prevention, particularly LDL cholesterol control, saves lives. Learn why family history demands a proactive approach — and why starting young matters. Read the full story

In recent years, there has been a noticeable shift in how individuals approach their health and wellbeing. With increasing public awareness around the importance of early detection and preventative medicine, combined with the reduced accessibility of primary care appointments, online home blood testing has rapidly gained popularity. This change has been further fuelled by the undeniable convenience of testing at home or visiting one of many independent providers offering blood test services across the UK. https://www.scvc.co.uk/naked-heart/the-rise-of-online-home-blood-testing-a-paradigm-shift-in-preventative-healthcare/   Read the full blog story

With continued advancements in imaging, pharmacology, and personalised medicine, the SCVC cardiometabolic clinic is positioned to lead the way in preventative cardiology. The integration of real-time metabolic assessments, cutting-edge lipid profiling, and targeted pharmacotherapy represents a paradigm shift in how cardiovascular risk is managed. For full blog

Stress is an unavoidable part of modern life. We encounter it at work, at home, in traffic, and even while reading the news. Although we often discuss stress casually, its impact on the human body is profound—particularly on the cardiovascular system. In this article, we will explore how stress affects the heart and blood vessels, drawing on clinical insights, expanding scientific knowledge, and practical stress-management strategies. By the end, you will see why stress is a critical factor in any heart health strategy, along with steps you can take to mitigate its harmful effects.   Read the blog article

Over the past decade, healthcare has experienced a remarkable evolution in how patients are monitored and managed remotely. Although the Covid-19 pandemic may have accelerated this trend, it is clear that even before the pandemic—when visits to see the doctor occasionally became nigh on impossible—modern technology was already paving the way for clinicians, particularly cardiologists, to care for their patients within the comfort of their own homes. By sending biometric and medical data through various monitoring devices to user-friendly dashboards, cardiology teams have been able to watch over patients without necessarily requiring them to come to clinic. This approach offers immense benefits: it minimises physical travel to the hospital or clinic, ensures timely interventions for emerging issues, and empowers patients to take greater responsibility for their own health.   Blog article

Having a stent or bypass is not the end of the story—it is the beginning of a new chapter in managing your cardiovascular health. With the right combination of medications, lifestyle changes, rehabilitation programmes, and vigilant follow-up using advanced diagnostic techniques, you can greatly reduce your risk of future events. Stay engaged with your healthcare team, keep informed about new therapies and guidelines, and commit to sustainable lifestyle adjustments to ensure the best possible long-term health. Read the full blog article

The body’s natural “fight or flight” response is crucial for survival in dangerous situations. This response increases heart rate, boosts blood pressure, and diverts blood to muscles, preparing us for rapid action. However, in modern life, where many people feel overstimulated, this response is often triggered unnecessarily—by stress, anxiety, or medical conditions—leading to elevated heart rates, and the symptom of palpitation. Beta-blockers step in to limit this excessive sympathetic drive, helping to restore a healthier, more stable internal state. Read the full article here

A “statin holiday” involves temporarily discontinuing your statin medication—typically for four to six weeks—to observe whether your symptoms improve. This break can provide valuable insights into whether statins are the culprit or if other factors, such as unrelated medical conditions or lifestyle changes, are contributing to your symptoms. The blog and podcast explain how a simple visual diary can be used to help assess the impact of the N-of-1 trial. However, it’s essential to discuss this approach with your healthcare provider before making any changes. Stopping statins abruptly without a plan may increase your cardiovascular risk, especially if you have a history of heart disease or other high-risk factors. Read more 

Aspirin, or acetylsalicylic acid, is one of the oldest and most widely used medications in the world. Well known for its analgesic effects, it was later discovered to be effective (in much smaller doses) in preventing platelet aggregation that had a pivotal role in arterial thrombosis. Its  role in inhibiting platelet activity has made it a cornerstone in the prevention and treatment of arterial thrombosis. In this article, we will explore the fascinating role of platelets in acute coronary thrombosis, the mechanisms by which aspirin exerts its protective effects, and the clinical considerations for its use.   https://www.scvc.co.uk/naked-heart/aspirin/

The timing of intervention in aortic stenosis is critical. Delaying surgery or transcatheter procedures until symptoms become severe or complications arise can lead to poorer outcomes. Conversely, intervening too early may expose patients to unnecessary procedural risks. For exceptionally fit individuals aged 75-85, timely intervention can be particularly advantageous, as they may tolerate surgical aortic valve replacement (SAVR) better than expected for their age. In these cases, earlier treatment may prevent irreversible damage to the heart and reduce the risks associated with waiting until the disease progresses further.   Read the full article 

The aortic valve is the ‘non return’ valve positioned to prevent oxygenated blood leaving the heart from refluxing back into the heart after each heart contraction. When this valve narrows, it restricts the flow of blood leaving the heart in a condition known as ‘aortic stenosis’. Aortic stenosis (AS) is a progressive and potentially life-threatening condition. It predominantly affects older adults and has significant implications for cardiovascular health, life expectancy, and quality of life.  The incidence of AS is climbing because of increased life expectancy. Timely intervention, especially in symptomatic patients or those with progressing stenosis, is essential to optimise outcomes. This article explores the nuances of AS diagnosis, treatment decisions, and the importance of patient involvement in the care pathway. Read the article

Angina pectoris, commonly known simply as angina, is not a diagnosis but a clinical syndrome characterised by chest pain or discomfort resulting from myocardial ischaemia—conditions under which the blood flow to the heart muscle is insufficient to meet its metabolic demands. This symptom can be the first indicator of coronary artery disease (CAD), the most common type of heart disease, which is why recent onset angina is usually investigated as a priority. Many people are not aware that there are many other causes of angina such as aortic valve narrowing (aortic stenosis), anaemia (low red cell count),  coronary spasm and even a mysterious cause that mimics the atherosclerotic cause called 'syndrome X' or microvascular angina.  In this longer podcast angina is discussed in greater depth. View the full article 

A young and healthy heart can double its stroke volume in a heartbeat. However, this capability diminishes with an ageing heart, especially one that has been subjected to high blood pressure, heart valve issues or metabolic conditions such as poor glucose control over many years. These factors cause the left ventricle to stiffen in many people as they age, limiting their left ventricle's  ability to change its stroke volume. Consequently, any change in cardiac output in older individuals, or those with a stiff heart, increasingly relies on increasing the heart rate. If the heart rate fails to increase with physical activity, cardiac output becomes constrained. Somewhat scarily, doctors call this "Chronotropic Incompetence" or "CI" for short.  Read the full story   

Getting your head around the difference between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) is a challenge for everyone. This is a technical discussion about why a stiff heart causes poor left ventricular suction and diastolic dysfunction. In part 2 of the podcast their is a major focus on what lifestyle measures during mid life may help fend off the risk of heart failure in later life.  Read the blog  

Beta blockers work on the beta receptor situated on the surface of cells that are affected by circulating adrenaline which the body releases in times of stress. Small amounts of adrenaline circulate, even at rest and help determine the resting heart rate and cardiac output. They also have a direct action on the Sinoatrial node which sets the heart rate and the AV node, which becomes very important in patients prone to atrial fibrillation and flutter. Beta blockers have been developed over 50 years and are used to treat a wide range of conditions, including palpitations due to arrhythmia, high blood pressure, anxiety, migraine to name just a few. For a cardiologist, beta blockers are a commonly used medication, possibly because we live in a high stress world and patients come to us with symptoms that are often improved by taking blockers. Cardioselective beta blockers are more popular as they are far less likely to trigger bronchoconstriction or asthma. Here are a few points that are often raised by our patients. Read the blog article  

Bradycardia, or a slow heart rate, is a term you might have come across in a medical report or perhaps during a routine checkup. For many, hearing that their heart rate is "too low" can trigger concern. But what does bradycardia actually mean? And when does a slow pulse become something to address with a healthcare professional? Let’s dive deeper into the causes, symptoms, and treatment options, to help demystify bradycardia and highlight when it is a natural variation and when it requires medical attention. Blog article  

In atrial fibrillation, the atrial tissue quivers at approximately 600 cycles per minute, which means that it has no useful pumping function. The left atrium in patients with atrial fibrillation, merely acts as a passive conduit between the lungs and the left ventricle. It no longer serves to prime the left ventricle, and as a result, there may be less blood entering the heart during diastole and thus less 'priming' occurs, so cardiac output may fall. If ever you have experienced a car's turbo charger going 'on the blink' you will know that the car still GOES, but not very well, since it too suffers loss of output.  The left atrial pressure in many such cases will increase, causing oedema or fluid in the alveolar space, reducing gas exchange and contributing to the symptom of breathlessness. Any stiffening of the left ventricle that for example accompanies old age, poor glycaemic control or indeed any condition that causes thickening of the left ventricle, such as hypertension or cardiomyopathy, therefore has a big impact on the ability of the left ventricle to relax and suck blood through from the left atrium and joining pulmonary veins, creating  backup of blood into the lung tissue. For more on this topic and other related blog articles and podcasts see https://www.scvc.co.uk/naked-heart/why-do-patients-in-atrial-fibrillation-get-breathless/

There is increasing evidence that high blood and tissue glucose levels may be an important risk factor for many non communicable diseases. CGM monitoring should be considered in all patients affected by heart disease, in order to define glucotype and current glucose profile- both easily treated if 'unhealthy' . Read more about glucose here https://www.scvc.co.uk/news/why-glucose-may-be-the-most-important-modifiable-risk-factor-for-humans/  

By 75 yrs of age 8.3 % of men and 5.7% of women are in AFib Many people are not aware they have it AFib is the cause of 20% of all stroke and upto half of all disabling hemiparetic stroke  AFib can cause heart attacks and heart failure For every case of permanent AFib there are 100s of cases of intermittent Afib called paroxysmal atrial fibrillation or ‘PAF’

Emerging evidence suggests that lower blood pressure targets may offer substantial benefits for cardiovascular health, particularly in those at higher risk. However, individual patient factors and potential side effects must be carefully considered. Further research is needed to refine optimal targets and individualise treatment strategies for long-term benefit. https://www.scvc.co.uk/naked-heart/optimal-blood-pressure-how-low-is-low-enough/

As only 10% of patients with high blood pressure are 'salt sensitive' (meaning that the blood pressure fails to fall in 90% of hypertensives, when salt intake is greatly reduced), it  seems plausible that consuming high levels of sodium from a young age can “programme” the cardiovascular system to maintain higher blood pressure later in life. Listen to the podcast and/or read about it here https://www.scvc.co.uk/health-screening/lets-talk-about-salt/

In today's world, where the pursuit of a healthy as well as a long life is everyone's goal, the importance of managing your own blood pressure has become an increasingly obvious. With an upsurge in patients over 80 experiencing heart failure linked to poorly controlled blood pressure from midlife, it's crucial that individuals, particularly from the age of 40 upwards, pay greater attention to their blood pressure readings to foster a healthy aging process. When blood pressure hovers at the borderline, many patients hesitate to start medication. This reluctance has spurred interest in non-pharmacological methods to lower blood pressure, aiming to delay the need for pharmaceutical intervention as much as possible for long-term benefits. One challenge in advocating non-pharmacological approaches is the lack of robust data from randomised controlled trials. Unlike pharmacological studies, these methods don't involve drug patents, which often leads to less scientific scrutiny. However, this shouldn't discourage individuals from exploring lifestyle and dietary changes to see if they can manage their blood pressure more effectively without necessarily requiring more medication. With the advent of accurate home blood pressure monitors, individuals can now undertake personal experiments to assess the impact of various interventions on their blood pressure. This "No of 1" experiment is gaining popularity, offering a personalised approach to managing blood pressure. The approach and methodology is discussed in this podcast. Read more details from the blog article below.  https://www.scvc.co.uk/heart-health/measuring-your-blood-pressure-at-home-using-a-home-cuff-monitor/

In the first podcast in the series, the discussion revolves around cholesterol and the fact that while your blood LDL cholesterol determines the development of coronary plaque, your levels are more about your genetics than necessarily what you eat. In contrast, what happens to coronary plaque over your lifetime and whether it causes a heart attack is more about 'inflammation',  what carbohydrates and UPF's you eat and your lifestyle.  To read more on this topic visit the blog https://www.scvc.co.uk/naked-heart/what-determines-ldl-bad-cholesterol/