Welcome, my name is Dr. Warrick Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol for better health. If you enjoy this podcast, I would be honored for a five-star review. You can share it with your family and friends. It may well save someone you love. Well, St Luke's Health have joined forces with Dr Warrick Bishop and the Healthy Heart Network to tackle heart disease in Tasmania. This partnership is a significant step towards St Luke's Health's vision of making Tasmania the healthiest island on the planet. To tell us more about that, I'm now joined by the Chief Health Officer of St Luke's Health, Luke Cameron. Good morning, Luke. Welcome to the show. Cheers, Gerbo. Thanks for having me. Interesting that your name's Luke and you're the Chief Health Officer at Luke's Health. Yeah, it wasn't well planned, but anyway, I'll take it. Fair enough. All right. Look, just first of all, for those of us who aren't aware, tell us about Dr. Warrick Bishop. Absolutely. So Dr. Bishop is a cardiologist based out of Hobart. He's actually somebody we're very fortunate to have in Tasmania. He's extremely passionate about preventing heart disease on a global scale. And he's actually a leading voice in using CT scanning as a measure for cardiovascular disease. Okay, so what made St Luke's Health join forces with Dr Bishop then? Was there a specific moment where you thought, I think we need to do something about this? Yeah, so Dr Bishop approached us about two years ago and sort of explained the... I guess his thoughts around how he believes we could better screen for cardiovascular disease. And we've been working together now to develop a pilot study that really will focus on finding better health outcomes. We've been working, I guess, for a couple of years to put the study together, and we're actually excited to be able to launch it. Excellent. All right, so what are the statistics in relation to heart disease in Tasmania? Can you tell us about that? Unfortunately, I can because they're not great. No. We'd much prefer that they'd be better, but heart disease is the leading cause of death in Tasmania with approximately one in eight deaths that can be attributed to heart disease. And there's around about 38,000 Tasmanians currently living with heart disease. And that's a statistic we'd love to improve as we move towards being the healthiest island on the planet. Absolutely. So what can we do in the meantime? Well, look, it's... It's a really interesting question, I guess. For those participants who want to be in the pilot study, we're looking to identify 100 people to undergo a virtual heart assessment that's put together by Dr Bishop and based on their results can be recommended for a coronary artery calcium score CT scan. We're hoping that on a small scale, we can identify how the calcium score fits into a cardiac assessment. and provide insight into, I guess, Tasmania's underlying cardiac health. Okay, so what are you really hoping will happen as a result of this collaboration? What we want to do right now with the pilot study is to understand how the cardiac artery calcium score actually fits into what should be an effective general cardiac assessment. We want to be able to continue using best practice, but also be able to see how this fits clinically into the Tasmanian population. Okay, and you reckon you can achieve this? Look, I think so. I mean, the pilot study, we released the pilot study to a cohort of our members, and we've had probably a 20% or 30% uptake already. That pilot study's only been out for a couple of days, so we're really excited. And we think what it shows is that people in Tasmania are really committed to working on better health outcomes. Oh, that's good. Well, it's pleasing to see that you've got off to that good start so far. Yeah, you must be reasonably happy. Oh, absolutely. It surprises me. when I see how passionate Tasmanians are about their health and wanting to actually try different things to really get a handle on how their health journey is going. Sure. Okay. Now, if anyone wants further details on cardiovascular disease, et cetera, and the current collaboration, where can they go? Online? Yeah, absolutely. So two websites. The first one is the St Luke's Health website, which is www.stlukes.com.au. And we have a health tab. And under that health tab, you'll actually see the pilot. The other one, which is actually Dr Warrick Bishop's website, it's called virtualheartcheck.com. And that'll give a lot more information to people. Great. Well, Chief Health Officer at St Luke's Health, Luke Cameron, joining us. Thanks for joining us this morning here at 7XS. Thanks a lot. Good on you. Okay, bye for now. Did you know that coronary artery disease kills one in four people? So most of us are likely to carry some risk or know someone who does. If you're interested in finding out more about how to evaluate that risk, check out www.virtualheartcheck.com.au It'll give you information about risk and what else can be done to be even more precise. Dr. Warrick Bishop is our tame private cardiologist working in Hobart. Everything he says is by way of information. This is not medical advice, and it's important to get your own medical advice from medical professionals with qualifications, etc. Warrick, hello. Good morning. Good morning, Rick. How are you? Very well, thank you. How do we determine heart disease risk currently? Look, Rick, we use a thing called a risk. calculator. Several decades ago, there were efforts to observe people who had heart attacks and look at their characteristics, their age, their smoking history, their diabetic status, all these sort of things, and put that into some sort of risk calculator. So a 50-year-old bloke, average cholesterol, average blood pressure would go into their GP and have those characteristics put into a risk calculator. And that risk calculator would say, oh, look, your risk is low to intermediate, maybe a 10% risk in 10 years. And we'd normally take that as something that we're pretty happy with. We'd reassure that person and say, maybe exercise a bit more and look after your diet and maybe check you again next year. The trouble with that, though, is that sort of approach is a population-based tool. So if you as a 50-year-old individual or me as a 50-year-old individual went in and asked our doctor, what's our risk of heart attack? And we got given that sort of answer. That represents the rate of event within the population of people who are just like us. It doesn't represent our personal risk. And what we're talking about is being more precise. And the way to do that is actually to scan the individual. Warrick, I mean, that statistical test as well, is it based on data from all of the population or is this yet another one of these things where the benchmarks are all based on men? The opportunity to scan the heart is for everyone, Rick. We really have now got the opportunity to look directly into someone's heart and give them a... very clear appraisal of what their actual risk is. This is a precision tool which moves us away from saying, look, you're in a population of people who might have a rate of event of 10% in the next 10 years. We can move away from that because that would mean literally 10% risk in 10 years means one in 10 people will have an event, which is not really acceptable. And we can move to precision care by looking at individual hearts. That can be male. or female, and the information is equally valid because it tells us, is there a problem? Yes or no? And if there is, is it mild, moderate or severe? And then we can put in strategies to make a difference. Oh, yes. No, I was talking about the previous information that we've been working from in the past. So this scans individual to you. And what exactly does it score, Warrick? What we look at is a surrogate for cholesterol moving into the arteries. We're looking at evidence or the footprint of something happening in the arteries and the way the body actually... deals with plaque in the arteries is it forms some calcification. Now, it turns out that calcium shines up bright and white on CT scanning. So it's a really nice way to be able to scan someone's heart and look for little white spots within the area of the arteries to identify whether there is a problem there or not. There either is or there isn't. And then if there is, we can quantify it. that gives us guidance to make the best decisions for that individual going forward to reduce their risk in the future. And if someone does risk reducing activity, Warrick, does that mean the scan shows up differently later? Look, it's incredibly variable, Rick, and being active, eating well, not smoking, avoiding diabetes, keeping a good weight, all these things are fantastic, but they don't. actually connect us with the complex mechanisms that occur at a cellular level that we don't understand. And so to get around guessing and get around those population type scores, the very best thing is to have a look. Because some people who exercise may have perfectly clear arteries. Some people who exercise may have a lot of plaque in their arteries. And until we look and identify it for that specific individual, we're really only guessing. Why do some people, you're listening to Dr. Warrick Bishop, it's 12 to 7 ABC Radio Hobart, talking about calcium scoring with a CT scan to assess your heart health. Why have some people been critical of this practice and why has it not been mainstreamed as something available universally if it's so good? So one of the biggest problems is that medical practitioners are extremely conservative and when we're looking at data to try and influence the way we... treat or monitor or manage people, we look for what's called outcome data from double-blind, randomised controlled trials. Now, that's a mouthful, but it basically means we take people with a certain situation and then divide them without anyone knowing, without the investigators of the trial knowing, into a treatment arm and a non-treatment arm and see if there's a positive outcome. The problem is you cannot run that sort of double-blind, randomised test with calcium scoring because it's unethical. If you think about it, starting with, say, 10,000 people, you calcium score them all, you know what their scores are, and then divide them into a treatment and non-treatment arm, there isn't an ethics committee in the world that would allow you to do that and say, look, you found people with calcium in their arteries and you're not going to treat them to see what the outcome is. And so there's been this... amazing gap through a requirement that you can't just let people have a cardiac event to prove the case. So there's been a reluctance to adopt it really from that perspective. So I think we're going to start to see a pragmatism come to it and say, look, if we can see that there's... build-up of plaque in the arteries or rust in the pipes, if you want an easy term for it. Why don't we act on that now? Let's not keep waiting for some clear-cut data to appear, which shows an outcome life benefit, because we may never get that study. Dr. Warrick Bishop, what would one of these tests set someone back? Are they expensive? No, not at all. It's in the order of hundreds of dollars. Unfortunately, because of this conundrum around outcome studies, there's no Medicare rebate for it. So people do have to be self-funded. However, saying that, it's cheaper than a set of tyres, Rick, and probably the most important engine in your entire life. So if you can put the pennies aside, it's certainly worth the investment to know what's going on. Are there trials in Tassie and how can people access these tests? Look, we've had various trials run through the Menzies Centre. Dr Marwick has led some of those, and he was actually in the Weekend Australian commenting on this particular sort of test. In Tassie, we can access the test by speaking with our GP. I've, in fact, put together a website called VirtualHeartCheck to allow people, or VirtualHeartCheck.com, to allow people to proactively... see if they're appropriate for scanning and actually purchase a scan online to save them the time of seeing a GP. And I actually have a very exciting bit of information about St. Luke's Health, who have just committed and started a pilot program working with me. to run this sort of testing for their membership. And that's actually an Australian leading initiative. So Tassie potentially is in a great position when it comes to starting to make a difference. Remember St. Luke's motto actually is they want to make Tasmania the healthiest island on the planet. Well, this is a great starting point because coronary disease accounts for more deaths than all cancers put together. Dr. Warren Bishop, yep, there you go. Make sure you get your own medical advice from your medical professionals. This is always just information here on ABC Radio Hobart. Great to talk to you this morning. Rick, thanks, and thanks for the opportunity to share, and good to talk to you. Join the Healthy Heart Network and become part of our growing community. Do you want to know more about your heart health and know more about your risk of heart attack? For $5 get lifetime access valued at over $55. The Healthy Heart Network has been designed to support and help you understand your risk of heart attack, your risk level where you are right now and the positive steps you can take to reduce that risk. Check it out at www.healthyheartnetwork.com and press the join the family button. Ever had a heart attack? Do you know someone who has? I'm sure you do. Perhaps you have a family history of heart disease. If so, have you heard of calcium scoring? It's a test that can detect heart disease in those who, air quotes, sit under the radar. So to chat more about that, welcome cardiologist Dr Warrick Bishop, who is on a mission to prevent heart attacks rather than trying to cure them. Good afternoon. Hi, Kim. How are you? Yeah, I'm well. Now, we know 50 men and women die every day in Australia due to heart attacks. 30% of these die suddenly without warning. We know coronary heart disease is a leading cause of death in Tasmania. The northwest coast has the highest incidences. Are we up to date or are the guidelines up to date on screening for cardiovascular disease? Look, as you're probably aware, there were a couple of lead articles in The Weekend Australia just gone. and they were flagging a conversation around using better technology to be more precise about how we identify people who are truly at risk of having a heart attack. For your listeners and for yourself, I'm not sure if you understand, but at the moment we use what would be called a population-based risk assessment tool to try and figure out what sort of risk someone might have of heart attack. And you'd be pretty familiar with this, and your listeners would be familiar. Go and see your doctor and the doctor will put some information into the computer, your age, your cholesterol level, smoking history, diabetic status, blood pressure, those sort of things, and come up with a number and say, oh, look, you look to be low risk or, well, you look to be high risk, we better put you on some treatment or you look to be at intermediate risk. Well, what I'd like to really get across to your listeners is that that sort of... That sort of assessment is a population-based risk tool. And what it's telling the individual is the rate of event of a heart problem in a population of people who have exactly the same characteristics. It's not actually telling us whether that is the person who's going to have a problem or not. And so the conversation about calcium scoring is one that says, look, instead of... trying to guess the rate of event within a population. Why don't we look specifically at the individual? Why don't we look specifically at their heart and see if we can evaluate the health of their arteries by using a scan, a simple tool that really just takes moments to undertake and is not particularly expensive. Well, I wanted to ask you to explain the calcium test. Is it intrusive? Is it painful? Or is it just as simple as a scan? Look, Kim, that's a great question. And I say to my own patients, it's as quick as one heartbeat. And it literally is. Our current modern machines take a quick x-ray snap and they do it literally within one heartbeat. A CT scanner is one of those big donut sort of arrangements of x-ray tubes that you lay on a table, they roll you a little way in. This is not even one of the claustrophobic sort of scans that we do. It's quick, it's cheap, it's effective, it's not intrusive, it doesn't hurt and it's not ridiculously expensive. What does it pick up then? It picks up calcium, Kim. What we're looking for is a surrogate marker of cholesterol in the arteries. And it turns out that when cholesterol goes into arteries, which is what we're worried about with heart attack and coronary disease, what follows soon after is a process that puts calcium in the arteries. Now, calcium is the same stuff that's in bones and... It lights up on CT scanning. So we can see it really clearly. We see these little white spots within the arteries and we go, yep, there's a problem there. Or there's nothing there. You're scaring me. Knowledge is the best way to overcome fear. Yeah, I know. And this is a fantastic way to identify people who are at risk, who otherwise appear well. and may be reassured by a population-based tool that doesn't really predict what their risk is. My whole practice these days, Kim, is around trying to identify these people who are at risk or not, and then put in place the best strategies for them. Because the really good news is if we can find people who have plaque in their arteries, calcium in their arteries, we can put in place strategies that can truly make a difference. for their risk of heart attack in the future and not be in a situation where they have an event out of the blue and people are scratching their heads going, I never saw that coming. All right. Well, I want to put my money where my mouth is and I know you have a website for people to book themselves in. I went through the process today and based on, my PayPal didn't work, but based on data entry, it found I'm in a group of people where the rate of the event is 10% to 20% in. 10 years now by vint do you mean heart attack yes is that good or bad well look so this is where there's a bit of a an a really odd quirk in the way we approach medicine the way we approach heart attack our current uh language around this kim would be to say look a 10 to 20 risk over the next 10 years is intermediate risk don't worry about that too much right okay but that that's in the context of heart attack which is really severe so let me put it in the in a different environment imagine you went and checked in with Virgin to fly to Melbourne and they said here you go Kim look just to let you know there's an intermediate risk of a problem with your plane falling out of the sky at 10% over the next 10 years we would be we would find that completely unacceptable so there's a weird a very odd misplaced lack of priority on heart attack and this conversation is the very thing we should be having. Some of the stats you presented at the beginning of this interview really highlight how important this condition is and how we really should be more focused and trying to prevent it. Why though isn't the test covered by Medicare? Yeah, well, that's a complicated and convoluted academic discussion to do with doctors and change. And one of the issues that we as doctors like to really make sure that is in place when we adopt new technology or new management or new therapies is we want to see what's called... double-blind randomized controlled trials. Now, your listeners, and you may well have heard of that, a double-blind randomized controlled trial is the highest level of evidence for any particular intervention we want to implement in our therapeutic regime. Now, if we think about calcium scoring, it's very easy to understand that we can't... justify ethically a double-blind randomized trial. Because a trial would be scanning 5,000 people, identifying what their calcium score is, and then separating them, randomizing them, into a treatment group and a non-treatment group. Now, any ethics committee in the Western world would say, hey, you can't find people who've got calcium in their arteries and randomize them to a non-treatment arm to prove that treatment actually works. And so we end up with these... academic discussions within the profession saying oh well we haven't got any evidence that actually makes a difference by knowing which to be honest doesn't make a lot of sense the trial hasn't been done to prove that we can treat people and save their lives to allow people to die would be unethical but the data and the observational data around the role of imaging is compelling the Technology's been around for 30 odd years and we have robust information that tells us that the amount of calcium... is closely linked to outcome for people. So it's a quirk, Kim. It doesn't make sense. Well, I'll get my PayPal working and I'm going to book in and have this calcium scoring done and I'd like to be able to report back to the listeners if it actually picks something up because I go that 10% to 20% in 10 years. I think, yeah, you're all right, Kim. Don't worry about it, mate. No worries. But I'll do this and we'll see what it finds. Fingers crossed. Well, I think it's incredibly valuable for anyone, to be honest. Kim, if it's all clear, great news. If it shows an issue, that's great news too because we can do something about it. And I often say to people, you know, we need to change our mindset around how we deal with health. We very much tend to see doctors when we're sick and wait for something to happen and get fixed up. But we don't do that with our car. Yeah, be proactive. We want to be the healthiest version of ourselves. It doesn't matter what age you are. So appreciate the conversation this afternoon, Dr Warrick Bishop, a cardiologist on a mission to prevent heart attacks rather than trying to cure them. Thank you so much for your time. Thank you, Kim. I hope you and your listeners got something from that. I'm sure we did. I mean, it is something that worries us all. And if it doesn't, it should. Ever wonder what your risk of heart attack is? After all it is the single biggest killer in the Western world. It accounts for 9 million deaths globally and the scary thing is it seems to be able to affect anyone. Well if you're interested in knowing more about your risk and understanding more about precision around that please check out a free risk check at www.virtualheartcheck.com dot au.
