[0:00] Welcome, my name is Dr. Maureen Bishop, I'm a cardiologist, an author and a keynote speaker. [0:06] I'm CEO of the Healthy Heart Network. I'm all about trying to help people [0:12] Live as well as possible. [0:13] for as long as possible. [0:15] Heart disease is huge in Australia. [0:18] Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. [0:26] This podcast is all about helping you understand blood pressure, weight, cholesterol and [0:32] for better health. [0:33] If you enjoy this podcast, I would be honoured for a five-star review. [0:37] you can share it with your family and friends. It may well save [0:41] someone you love. [0:42] Hi, so if you're interested in finding out a bit more useful information to help you with your best heart health journey, then today I've got an interview which you may well wish to stay tuned for. My name is Dr. Warrick Bishop. I'd really like to welcome you to my podcast and videocastation, but even more than that, I'd like to welcome Dr. Steve Fenton, who's a cardiology colleague. We've [1:12] and so we are kindred spirits. Steve heads up Bly Cardiology. He's well known in Australian cardiological circles. He is the organiser of the Port Douglas meeting, a legendary meeting that cardiologists right around Australia and around the world put in their diary and make sure they get there. And now Steve is an author and it's in that regard that I'm catching up with him today. Hi Steve, how are you? Yeah, g'day Warrick, very well, great to be with you and your listeners. [1:42] Thanks. [1:43] Yeah, look, I appreciate your time. I know you're super busy. So... [1:48] Steve has gone to the trouble of writing a book. And I can say that because I know the trouble it takes. [1:54] to write a book. Steve's written a book called The 5CH Lifestyle. So... [2:00] I've had a flick through it. I've got a heap of questions. But Steve, in a couple of words, in a sort of elevator pitch... [2:07] How would you describe this book to those who are listening or watching? [2:11] Well, Warrick, the book is a compilation of my experience over many years. I've been a cardiologist for over 40 years, which sounds troubling to me, but that's the fact. And for about 20 of those years, I've very much been a preventative cardiologist. And there's really two key messages in this book. One is the best and probably only way to prevent a heart attack is early detection of the underlying cause, which is plaque or atherosclerosis. [2:41] We can maybe talk about that a bit more. And the best way to reduce the risk of having that or reducing it if you've already got it and reducing the risk is to... [2:51] Follow a holistic program, which at the forefront is a diet, low in saturated fat, trans fats, sugars, other toxins, which I've developed a simple method called the 5CHs. And on top of that, a holistic lifestyle program, which includes many things we could have a chat about. So it's early detection for prevention, and it's changing your life so that you start eating healthy and do a whole bunch of other things from a lifestyle point of view. [3:20] That's great. Look, for those listening, there's obviously enough of a teaser there for you to stay on. So keep tuned. And if you enjoy this, please remember to share it. I've now got the book. I've had the chance to go through it. I wanted to flag a couple of things, Steve. [3:35] Because a few things stuck out. Just in the very opening of the book, you've got some fantastic positive comments from people who I see as some of the leaders, not just locally, but internationally when it comes to cardiovascular health and well-being. So that certainly speaks volumes to the respect and the professional career that you've had. So congratulations on that. [4:05] who's who of cardiology. [4:07] in the preventive space in the world. Pick up this book and you'll see the first couple of pages... [4:12] dedicated to positive comments to the book from colleagues so well done on that steve i'm super thanks i'm very proud of that and it's um you know a great source of joy that that i know that many well i know all of those people and they've thought positively of the messages in the book [4:34] And equally, at the end of the book, in the acknowledgements, I see that they've also had some opportunity to have input and feedback, which I know from my own personal experience is incredibly valuable because a fresh set of eyes and another perspective is always something that is... [4:50] that's invaluable in trying to bring the very best story to people. So, yeah, good stuff. Mm-hmm. [4:58] Bye. [4:59] What I did notice is that the dedication for the book was to your father and [5:06] Thank you. [5:08] Without too much detail, obviously the dedication there points to him having a heart attack at a young age. And it begs the question, Steve, was that part of what informed your... [5:20] Your medical genie? [5:22] Well, I think it was very much Warrick, somewhat on a conscious level and somewhat on an unconscious level. So, you know, this goes back to 1962 when I was 10. [5:37] I mean, in broad terms, it just makes me very interested in the history of prevention or lack of prevention, perhaps, back in those days. But my father had his first heart attack at the age of 45. [5:51] And [5:53] My sister and I were told he'd had a coronary thrombosis and we looked that up in a dictionary and it didn't sound so great. But to cut a long story short, ever since then, and including my journey into cardiology, whether that was connected or not, I don't know, but I think that was fate perhaps. [6:13] But ever since then, the question in my mind was always, how could that have been prevented? You know, how could a 45-year-old person who was clearly at risk and then had an event, which was potentially fatal, lucky he survived that one, but he did have a second one 20 years later, um... [6:31] Okay, how could that have been picked up? And the answer is... [6:36] At the time, nothing, because we didn't have the technology, we didn't know anything. But now today, if there is somebody like that at any age, but obviously it's a very concerning thing at a young age at risk, broadly speaking, if we're going to take this into the population at risk, [6:53] The answer is the CT Coronary Calcium School. And you and I, through our training, have seen a lot of different tests. We've seen ECGs. We've seen... [7:01] um echoes and nuclear tests and formal coronary andograms and ct angiograms which i'll come back to and blood tests and all sorts of markers but [7:11] In simple terms, the one test people out there listening to this could have, now this is assuming they are not having any symptoms and have never had an event. That's who we're really talking about. This is called primary prevention, as opposed to secondary prevention, which your listeners probably know, but just to repeat, include people who've already had a heart attack or a stent or a bypass or a stroke. So in primary prevention, for the majority of the population, a starting point, a screening test that is going to at least tell them [7:41] It's a CT coronary calcium school. And [7:45] You know, it wasn't really until fairly recently... [7:49] that [7:52] that I've come to feel so passionately about not only that that's the right way to do this, but also I've become increasingly, I suppose, jaundiced by the [8:05] persistent and entrenched view of our colleges and mainstream [8:14] authorities about [8:16] what the alternative is. And that was historically terrific. They did a great job. So this goes back to Framingham, which is just after World War II. I might sort of explain this to you listeners. People were having heart attacks. The American president was having a heart attack at the time. People wanted to know, the United States government wanted to know, why are people dropping like flies of heart attacks? And in those days, the mortality rate was 50%. So it was a very serious business. [8:44] And they conducted a study in this little town called Framingham in the United States. [8:49] It had a limitation, it was restricted to white Americans and didn't include other races and that's subsequently been addressed. But they basically said there are four factors that we think are important in causing or being associated with heart attacks. And that was smoking, high blood pressure, diabetes and cholesterol. And... [9:10] Fifty years later, in 1998, they developed a calculator [9:14] based on those four factors called the Framingham Risk Calculator. And that's what's basically still used today. In Australia, we call it the Australian Cardiovascular Risk Calculator. In America, they had Framingham, then they had the pool cohort equation, and now they've got something called PREVENT. [9:32] The problem I have, and I talk about it in the book, is that these are highly inaccurate. I think they're dangerously inaccurate, and they don't include plaque testing. [9:40] And when we're talking about plaque testing, calcium score would be... [9:45] one of them but there are others and i i this bothers me because i don't think if i cast my mind back to when i was a 10 year old boy with a 45 year old father he would have been at low risk on that calculator and yet he nearly died and certainly had a big heart attack that affected his longevity and the same thing happens today i i you and i hear of these cases all the time people just dropping dead and we know from the statistics that about half of folks who [10:13] have a big heart attack, have no warning symptoms until just before, maybe a few hours before. And so we can't rely on symptoms. And this is a really important message for your listeners. We can't rely on symptoms. We have to be doing something proactive. And one of the problems with Framingham or Prevental, whichever one you want to choose, is that they're inaccurate. And the question is, why are they inaccurate? And the answer is they're population-based symptoms. [10:37] calculators they work very well in a population but the individual that walks into my rooms or your rooms is not a population he or she is an individual [10:48] And these calculators do not work in individuals accurately. Young people will be invariably low risk and yet they could be at high risk. Older folks are often at high risk on the calculators but many times they are at low risk. [11:05] And I just think we need to abandon these calculators and include, we know there's at least [11:11] well over 20 things that matter in addition to those four what we call traditional risk factors and they're listed in the book and i've created what's called a personal risk profile score based on those so anyone listening can go onto our webpage and do this for free it's an interactive [11:27] um, [11:28] a tool where they just tick boxes and work out how many of those things. Now, the things that are not traditional risk factors are quite a large list. Before we jump on those, Steve, because there's a lot there. [11:41] Let me just echo your sentiment, because I think for anyone who's tuned into certainly the podcast or videos that I've done over time or any of my books, they've recognized that you and I are really quite aligned together. [11:58] in this space of trying to bring precision to risk, and that difference or the disconnect between a risk calculator, I'll just touch on that again for a moment, because if an individual goes and sees their GP and gets told, [12:13] your risk is 5% in the next five years, this is low risk. [12:17] then patients historically have taken that as a good sign. They believe if they're told their risk is low, 5% in five years, that they're fine. But what they're not really being told... [12:29] is that [12:31] That risk calculator is actually saying, if we take 100 people with the same characteristics as you, and follow those 100 people for five years, five of those people have a heart attack. And we just don't know if you are one of the five. And this is where screening the 100 using the tools that we're talking about, particularly calcium scoring, [12:56] can identify those people who have plaque or signs of plaque in their arteries so that we can actually be forewarned. And I think you and I are rock solid on really trying to advocate that. And I think it's incredibly important for people to be aware so that they can have that conversation. [13:16] While you're talking about that risk profiler, just give us the website for that again, because people listening may want to check out if they're... [13:26] at risk [13:28] Or if I... [13:29] Calcium score would be recommended. [13:33] So I'll get your risk profile web address, but I'll also mention I've got a web address called Virtual Heart Check. So if people do need or are indicated through your profile that a scan might be beneficial, I've actually got a website called Virtual Heart Check, which allows people... [13:50] to purchase a scan online without the need to see a GP or even a specialist. They can book that from their own home in any major centre in Australia. So maybe we should get together, Steve, because there's a definite complementary service provision there in those areas. [14:05] website system, what's your [14:07] What's your website for people to check out? [14:10] Yeah, well, it's www.the5chlifestyle.com, and that's the book's webpage. It's also linked through my practice, www.blycardiology.com.au. They can find it either way, but www.the5chlifestyle.com.au. [14:31] Thank you. [14:32] What I might do is come back to the book and the introduction, because one of the things that you flag right from the get-go in your introduction is, [14:39] is almost the complacency about coronary artery disease. And this really ties in with [14:44] that introduction that you spoke about with Framingham, Eisenhower having his event and where we are now, because right in your introduction, you talk about if a plane fell out of the sky and, [14:56] and 200 people died, the significance of that and how it would make us all sit up and pay attention and yet people are dying at the same rate or more from heart disease and nothing's happening. So speak to that for me. Well I played around with the numbers some years ago when I was trying to work out the significance of this. We know that heart attacks are the leading cause of death. Now admittedly the [15:24] The numbers have come down since the 1960s considerably, and that's because of public health programs, reducing smoking, and certain things. But the numbers are starting to go up again, and that's because of the rising epidemics of obesity, diabetes, and... [15:45] You know, I think... [15:49] The problem is that we just need to understand that all these other factors are very important. [16:00] And so [16:02] Is that what you're asking me or I've just made a mistake there? You get caught and I'd be interested in your thoughts on the psyche around prevention. Well, look, it's the impact really. I mean, I think, you know, I just, I hear this all the time, but I just heard a few weeks ago when I was at a concert that, you know, this little kid had lost his father of a heart attack of age 50. [16:24] And, you know, I think there's a misunderstanding about how [16:29] frequent this is. We do get occasional shame-worn times when people who are famous get on the front page, but it's happening all the time. So in America, this is a hard statistic for people who understand. In Australia, it's one plane a week of people who are having heart attacks and dying who have no knowledge of heart disease. In America, it's 12 to 13 planes a week. [16:51] Now imagine that if 12 planes crashed last week in the United States, [16:56] questions would be asked about [16:58] air safety and it would be horrific, it would be in the news. And yet [17:02] Each and every week in America, about 12 or 13 plane loads full of people are dying of heart attacks with no prior warning and no prior symptoms. So... [17:12] That's the extent of the problem. And I guess another way of looking at it is that [17:16] preventative cardiologists like you and me, [17:19] We feel that this is a preventable disease. [17:22] We feel that 90% of heart attacks are preventable, probably. And yet we're not preventing them. [17:29] Why are we not preventing them? Because we're not identifying them early enough. We've got the tools to do it. But so many people who have a heart attack have never had a heart check. And this is another hobby horse of mine, I suppose. When you go for a Medicare rebated heart check in Australia, [17:47] You spend a fairly short time with your GP. [17:50] and the [17:51] GP will do a cholesterol, hopefully a blood pressure, ask about symptoms, maybe ask about your family history, although that's not necessarily the case, and... [18:02] and do some blood. So they'll have a quick look and that's called a heart check. [18:07] But there is no... [18:09] Actual heart check. This is a misnomer. It's a risk factor check. And so people can go along and have this so-called heart check and think, well, their heart's being checked, but nothing could be further from the truth. This is a risk factor check. They could be sitting there with a calcium score that's extremely high, reflecting a very high risk factor. [18:25] of underlying atherosclerosis. [18:27] and their numbers on those traditional risk factors may not be that marked. I had a patient not that long ago, [18:34] and [18:35] And he's now... [18:37] in his late 70s. I've been looking after him for a long time. [18:42] And he said... [18:44] You know, he was clearly distressed and unhappy and very sad. And he said, I lost my son. My son had a sudden heart attack. [18:53] Now, [18:55] The son had gone to his GP... [18:57] Yeah. [18:58] And, [19:00] the gp would put him on a statin that's a drug to lower cholesterol [19:04] But he... [19:06] I don't know if the GP had done a Framingham or a cardiovascular calculator, but he was at low risk based on that. And yet... [19:14] He had depression. That's a risk factor, not in the traditional calculators. He had obesity. He was sedentary. He had obstructive sleep apnea. He had a very high saturated fat diet most of his life. [19:28] Um... [19:29] And so he had this host of factors which are in my risk profile score. But he was at lower risk based on the registrarian risk factors. And although his GP had put him on a statin, he wasn't really treated effectively to a low level. What we aim for is a certain LDL, bad cholesterol level. And so this to me is where the system is failing. He wasn't, you know, he passed on. I think at the age of 47. That's not good. [19:59] And... [20:02] And on top of that, clearly he had a family history with his father having a long history of coronary artery disease. So... [20:08] You know, the GPs are being told to use the Australian cardiovascular switch calculator. [20:13] But what's the point when you have people [20:15] dying because they're not being picked up. [20:18] is more than low risk. And that's my message. That's my mission, I suppose, to try to change the system so that GPs are educated. What I would really love to do, Oric, with this book, is bring patients and GPs together. I have a very high regard for GPs. They're just not getting the right information at the moment. Why don't I just jump in there, Steve, just for a moment. Yeah. Because of time, we've hit about 20-odd minutes, and what I'd love to do is actually break... [20:47] pretty soon, so that we can come back and actually cover what the [20:53] CHs are. I think that'll be really important and then wrap up with some of the advice that is clearly displayed through your book. As we do that though, just to finish off this one and to follow up with the story that you just had. [21:09] I think there's a number of failings with our efforts at prevention. One of the really big ones is the complacency, which is why I touched on the psychology of it. And I'll tell you a story that... [21:24] There was a personal story of mine just recently. I had a patient who was a GP, and one of those values when a colleague comes to see you, you take that pretty seriously because it's a compliment. This particular GP had some complicated heart issues. It took a little while to sort him out. When we finished, I actually gave him a card. [21:47] with the address for that website to get a calcium score for his wife. I said, here's the virtual heart check. [21:54] website, go and get your wife checked. [21:57] And I'll see you in a year. [21:59] Steve, I saw this colleague in a year. I asked him, how are you going? He said, oh, no good. I said, it's terrible. What's up? He said, my wife died. [22:08] I said, "Oh, that's awful. She died six months ago from a heart attack." [22:13] He said, [22:14] Thank you. [22:15] Steve, I had two profound feelings at that stage, two profound emotions. And the first one was anger. [22:22] I was so cross... [22:24] I was so angry, I wanted to almost shake this. [22:28] fellow, scream at him and shout and say, your wife should not have died. If you'd got a scan done when I'd suggested, she would have been identified and she would still be here today. [22:42] Mm-hmm. [22:42] And that's complacency. The other thing, of course, the other emotion I felt, of course, was sadness. And because of his loss. But we have this remarkable... [22:53] complacency and your [22:56] aeroplane example, a plane falling out of the sky, people are terrified about that. They want answers. [23:03] But the same number of people die from a condition that up until you're sick, you feel well. [23:09] ignore it, it just does my head in as I know it does your head in [23:15] Yeah, 100%, man. And I share your feeling of anger. Yeah. [23:19] when I hear about tragedies. And we know that a calcium score is a very useful test in the right patients at the right age. We know that. [23:28] And yet the guidelines don't give it the emphasis it needs to and somebody's got to call it out and that's what I'm doing in the book and that's what you're doing with your work. Because all it says in the guidelines, so you listen to understand, if you're at intermediate risk and your doctor's uncertain about medication, then you can have a calcium score. There are two problems with that. The first is... [23:51] Intermediate risk is determined by the Framingham risk factors. And I've just explained they're totally inaccurate. So that pigeonholing of patients into immediate is wrong. Second thing is it depends on your patient and doctor's shared decision making as to whether there's uncertainty. I can tell you after 40 years of cardiology, and I'm sure you could support this, there's always uncertainty. Until you've determined a diagnosis, you don't have a management plan. And this is a big problem. [24:21] Diagnosis precedes management. [24:23] But we're not doing that. We're managing people on a guesswork calculator instead of making a diagnosis of atherosclerosis and then determining management. So diagnosis before management, there's always uncertainty. We can't be certain if somebody's in the intermediate group. We know people in low to intermediate and high risk all benefit from calcium sclery. Absolutely. That's a great spot to finish part one. If you've got time, Steve, sometime, we will bring you back and we'll do a part two [24:53] We're both passionate about saving lives and there will be people who listen to this who hopefully... [25:01] the message will reach them and hopefully we can save a life because basically that's what it's all about. So for those listening, thank you for staying tuned this long. I really do appreciate your time. I do recognize that all of us have a limited amount of time. So if you listen this far, I do appreciate that. Steve, I know you're busy, so thank you so much for joining us. And I really look forward to welcoming you to part two of this podcast series. [25:29] And, um... [25:31] For those who are interested, please subscribe and share, because I really appreciate getting this information out there. Until next time, I hope you live as well as possible for as long as possible. Take care. [25:42] and bye for now. Join the Healthy Heart Network and become part of our growing community. 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