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Asymptomatic Coronary Artery Disease | What Should You Do?

Asymptomatic Coronary Artery Disease Explained

So, you’ve got asymptomatic coronary artery disease. Should you do something or nothing? Dr Malik runs through your options, breaking down the complexities in a simple way.

What is Coronary Artery Disease (CAD)?

Coronary Artery Disease (CAD) is a condition involving the coronary arteries. You have a left and right coronary artery. These are the first branches that come off the aorta, and they supply blood to your heart. Normally, they have smooth internal linings and can expand to increase blood supply during physical activities, like exercise. If you start having atherosclerosis (furring up), they can become narrow, meaning they fail to supply enough blood to the heart during exercise. 

Are there any symptoms I should be watching out for?

Angina is the most common symptom of CAD. It’s the feeling of “pain”, discomfort, breathlessness or tightness that is brought on with exercise and is a result of the heart not getting enough blood. In some patients, the heart can feel the strain, but you may not feel the pain! This is because pain is a subjective feeling. But also, the symptoms can be confused with indigestion, heartburn, being unfit, getting older… or of course, you may truly have no symptoms.

How is asymptomatic CAD screened for?

We can use several methods to screen for CAD.

  • Stress test: to check for any strain on your heart.
  • CT coronary angiogram: to check for any evidence of furring up – this is often the way we pick up more minor narrowings that may not cause symptoms
  • Invasive angiogram: to diagnose CAD and measure the disease’s severity

Coronary Artery Disease treatment options

If you do have Coronary Artery Disease, there are several treatment options.

1. Medical therapy only

  • Anti-platelets such as aspirin. There’s good evidence in younger patients, but more side effects in older patients.
  • Statins to lower lipids. Statins carry a lower risk and are worth it – I am on a statin!
  • Anti-anginal pills (but only if you have symptoms of angina):
    • Nitrates
    • Beta-blockers
    • Calcium channel blockers
    • Nicorandil
    • Ranolazine
    • Colchicine – an anti-inflammatory that’s now useful in treating coronary disease

2. Combining medical therapy with angioplasty & stenting

Medical therapy plus angioplasty and stenting (also known as PTCA or PCI is a less invasive option).  Angioplasty is usually done through the wrist and involves placing a stent or scaffold to open up the blockage. The latest data shows that historically, we’ve carried out too much angioplasty, so please be aware that angioplasty is only really for symptom control. Outside of having an acute heart attack, stents are unlikely to extend your lifespan.

3. Combining medical therapy with coronary bypass surgery (CABG)

If you have severe CAD, Coronary Bypass Surgery offers a “full replumbing” and may help you live longer. 

There are different types of surgeries: 

  • On pump surgery vs off pump surgery
  • Mini access surgery vs open chest surgery
  • Full arterial revascularisation vs using a LIMA graft and veins

But you shouldn’t worry too much about the options – our private heart specialists are here to advise on the right treatment that improves your quality of life. 

How do we decide which treatment is best?

We consider the following questions:

  1. Are you robust/strong enough to take the treatment offered? 
  2. What does the evidence from trials, medical therapy and PCI versus CABG show? You may only need to improve your lifestyle, weight and blood pressure. 
  3. What do YOU want? You may want a less invasive treatment, but if that’s significantly worse for you, we may choose not to offer that to you. Our cardiologists only advise on procedures that are going to be best for you and your quality of life.

Who finally chooses?

You’re allowed to make a bad choice – it’s your body after all. But we don’t have to carry out a certain treatment if we disagree. You may find another cardiologist who’ll do it, but that won’t change the evidence base or facts.  Real patients are harder to manage than trial patients. The Multidisciplinary team (MDT) is useful when a plan is not clear-cut – but in the end, you and your own doctor have to agree on a plan!


Watch Dr Malik delivering a talk to Cardiothoracic surgical trainees and running through the evidence – should you do something, or nothing? 

Book your consultation

If you have asymptomatic Coronary Artery Disease and are struggling to decide what to do, please book a consultation, I will be more than happy to see you. Let’s get the quality of your life back.

Article by Dr Malik, a UK leading cardiologist. He works at One Welbeck Heart Health – London’s Largest Private Cardiology Group, and at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, one of the largest NHS Trusts in the UK.

Paravalvular Leak | A Challenging Case With Dr Malik

How Dr Malik Closed A Challenging Paravalvular Leak

Dr Malik talks through a challenging case, explaining what a paravalvular leak is and the best available treatments. 

With one of the UK’s largest experiences of closing paravalvular and other odd leaks, he’s got the expertise to keep your mind at ease and help you avoid the need for surgery. Let’s delve into the case study.

Watch Dr Malik discuss a tricky case of Paravalvular leak

Video: Click Here

“Watch me deliver a presentation to a group of surgeons on this tricky case. A complication of open surgical valve replacement, with a tricky hole was left behind. I managed to plug it and reduce the leak. The patient has felt so much better ever since!”

What is a paravalvular leak?

After surgical valve replacement, leaks can sometimes occur. Either THROUGH  the valve – or  BY THE SIDE  of it – due to a weakness in the tissues which allows the sutures to loosen. If the leak is severe enough, the valve can even start “rocking”. 

In this particular case that I presented, however, a suture seemed to have created an additional hole, connecting the left ventricle to the right atrium. This is what’s known as a Gerbode Defect.

What treatments are there for Paravalvular Leak?

There are several options:

  • Medical therapy. If you’ve got no symptoms and the heart is stable, it may not be necessary to close the leak. Not every hole needs closing.
  • Transcatheter device placement. Plug it with a transcatheter device put in from the leg.
  • Redo surgery. If the surgical risk isn’t too high and a plug’s not possible, re-doing the surgery will likely be your best option.

What tests do I need?

For a suspected paravalvular leak, you’ll need a full assessment. This includes:

Worried about your heart?

Please book a consultation or contact us at With our patient-centred approach, you’ll feel confident you’re in safe hands.

Article by Dr Malik, a UK leading cardiologist. He works at One Welbeck Heart Health – London’s Largest Private Cardiology Group, and at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, one of the largest NHS Trusts in the UK.

What is the Mitral Valve? | Dr Malik Explains

Mitral Valves Explained by UK Leading Cardiologist

Learn all about Mitral Valves with Dr Malik – one of the UK’s leading heart surgeons, known for his simple explanations of complex heart problems. Let’s explore what the mitral valve is, which side it’s located and the best treatment options for when it leaks.

What is a Mitral valve?

The Mitral valve is the inflow valve of the heart, located on the left-hand side. It has two leaflets that open and close in sync with the heartbeat.  Mitral valves can encounter issues such as narrowing, typically caused by Rheumatic Heart disease. It can also experience leakage, often due to problems at the valve’s base that cause it to lose support, or issues with the leaflets not meeting properly (leading to the blood leaking backwards).

What’s the best treatment for problems with the mitral valve?

The treatment options depend on the problem.

Stenosis (or narrowing)

A balloon can be used in younger patients to open it up. In older patients, surgery is usually needed.

Regurgitation or leaking

Regurgitation or leaking in the Mitral valve can be treated with surgery, typically an open valve repair or replacement. But if surgery is high-risk, a “clip” can be placed on the valve to reduce (but not cure) the leak.

Issues with a failing surgical valve

When a surgical valve begins to fail, there are a few potential issues we must consider.

  • Leakage around the valve’s edge. If there’s a leakage around the valve’s edge, one option is to plug the leak from the leg. Alternatively, another round of surgery may fix the issue.
  • Narrowing or leaking inside the valve.  The treatment for internal valve leaking depends on the type of valve.
  • Metallic valve. Another round of surgery will almost always be required.
  • Tissue valve. A TAVI valve could be inserted. Dr Malik is a national proctor for this procedure and teaches others how to do it.

How do we assess the mitral valve?

The mitral valve can be listened to with a stethoscope. It makes sounds (murmurs) if it’s NOT working well. If we suspect a problem, we’ll order more tests, such as:

 Watch Dr Malik carry out a malfunctioning Mitral valve replacement

Dr Malik carries out these procedures routinely. Watch and learn:

Click Here

“I performed this procedure under general anaesthetic via a small puncture in the groin. The latest technology can achieve outstanding results, even in high-risk patients!”

Worried about your heart?

Please book a consultation or contact to put your mind at ease and get the latest, high-quality tests your heart deserves.

Article by Dr Malik, a UK leading cardiologist. He works at One Welbeck Heart Health – London’s Largest Private Cardiology Group, and at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, one of the largest NHS Trusts in the UK

How We Helped Amy Recover From Her Stroke Back To Full Health

Learn how Dr Malik helped Amy recover from her stroke and go back to full health. She’s now happy, healthy and fully active! 


Amy’s had a very good recovery and kindly agreed to have the procedure filmed.

Watch her journey below.


Amy Jones is an Instagram influencer who had a PFO closure at One Welbeck Heart Health with Dr Iqbal Malik – who leads the NHS Structural Heart Service at Imperial College Healthcare NHS Trust.

Dr Malik says: “We decided to close the PFO, and Amy agreed for it to be filmed to help other people who were due to have the procedure. We used a Cocoon device. It went well and Amy is now back to full health and fully active! I am very grateful for her help in making this video”


First, Amy had a thorough series of investigations to diagnose the cause of her stroke.

What were the results?

The Bubble Echocardiogram showed she had shunting of the microbubbles of the right side of the heart across to the left side. Even spontaneously at rest. Amy’s stroke appeared to be caused by the PFO (Patent Foramen Ovale) – a flap valve in the heart that is also present in 25% of healthy people. This meant Amy was suitable for a PFO Closure to significantly lower the risk of another stroke.

A straightforward procedure

The team made Amy feel comfortable and relaxed throughout the investigations and procedure.

When she woke up, Dr Malik told her: “The procedure went really well. As straightforward as a PFO closure can go really! The tunnel was really quite small, so I’m hopeful that in 2 weeks’ time, the button will have really sealed up and the bubble study will be negative. Then we can forget about the PFO and get on with life.”

Amazing aftercare

When Amy got home from her procedure, the friendly specialist nurse Helda gave her a call to make sure everything was okay. Amy told her she had a bit of pain, and Helda reassured her that soreness in the throat and groin are expected, as well as some minor palpitations. This made Amy feel very at ease knowing her recovery is on the right track. We offer full support after you leave the clinic, which our patients really value.

Back to full health

Fortunately, Amy did really well and only 2 weeks after the procedure, we confirmed with a repeat bubble echocardiogram that she was fully fixed!


Before a PFO


After a PFO

2 weeks after the procedure, there are no longer any bubbles: at rest, with a sniff, or even with a strong Valsalva (straining). Amy is now happy, healthy and fully active without having to worry about her PFO.

Have you got a PFO?

If you have a PFO and want Dr Malik’s help, visit our Contact Us page and make an enquiry today. Join Amy and get the quality of your life back!

What Is Cholesterol & How Can I Lower It? An Article By Dr Malik

Dr Malik was in the Telegraph again – this time commenting on the best time to get your cholesterol checked. He argues against universal testing at age 30 as there needs to be evidence that this will make a useful difference to the population’s risk of heart attack and stroke. Here’s why.


What is a cholesterol test?

A cholesterol check is a blood test.

It is done at age 40 as part of a health check. Checking earlier MIGHT motivate some people to change, but it would be better to address all the lifestyle issues that affect the Western Middle age population, such as obesity, blood pressure, smoking, lack of exercise, diabetes – rather than a cholesterol number alone. Those with risk factors should certainly be tested. Those without can probably wait until 40.


If you do want to know what your cholesterol is, then lets take a look at the important numbers and what they mean:

Good OK High risk
Total Cholesterol (TC) <4 >5 >6
LDL cholesterol (LDL)  <2 2-3 >3
Ratio TC/HDL  <4 4-5 >6

What types of cholesterol are there?

  • Low-density lipoprotein (LDL) or “bad” cholesterol. Having high levels of LDL cholesterol can lead to plaque buildup in your arteries and result in heart disease or stroke.
  • High-density lipoprotein (HDL) or “good” cholesterol. HDL is known as “good” cholesterol because high levels of it can lower your risk of heart disease and stroke.
  • Triglycerides, (TG). A type of fat in your blood that your body uses for energy. The combination of high levels of triglycerides with low HDL cholesterol or high LDL cholesterol levels can increase your risk for heart attack and stroke.
  • Total cholesterol (TC). The total amount of cholesterol in your blood based on your HDL, LDL, and triglycerides numbers.


How can you lower cholesterol?

Diet & exercise

  • Carbohydrate are more of an enemy to you that saturated fats
  • Take 5 portions of fresh vegetables and fruit a day


Weight loss

  • Walk 10,000 steps a day
  • Try reducing rice/bread/naan/pasta/potatoes/alcohol. These are all carbohydrate calories.
  • Try a diet:
    • Eat less (easy to say!!
    • The 5:2 diet – for a man 1000 calories 2 days of the week, more normal for 5 days; for a woman 600 calories!
    • Intermittent Fasting – eat for ONLY 8 hours of the day, e.g. from Midday to 8pm. No calories outside this!
      • Tea with milk? No
      • Black tea? Yes




  • Well validated and well tolerated
  • They can reduce your LDL cholesterol by around 30%, sometimes even 50% with high doses.



  • Weak on its own, but good in combination.
  • Lower LDL cholesterol (sometimes called ‘bad cholesterol’) by 15-22% when used by itself, or 21-27% if it’s used in combination with a statin.


Bempedoic Acid

  • A newer tablet that works well. Take just once a day.
  • Like statins, bempedoic acid lowers cholesterol in the blood by reducing the production of cholesterol in the liver. Statins block an enzyme known as HMG-CoA reductase. Bempedoic acid works in a similar way, by slowing down a different enzyme in the cholesterol production pathway known as ATP citrate lyase – but only in the liver. This means there are more LDL receptors in the liver, which helps to remove more LDL cholesterol from the blood.
  • They reduce LDL cholesterol by between 17-28% after 12 weeks.. When combined with ezetimibe, bempedoic acid can give up to 38% reduction in LDL cholesterol.
  • Unlike statins, bempedoic acid only works in the liver so it is much less likely to cause side effects affecting the muscles – one of the main reasons some people can’t take statins.


PCSK-9 inhibitors

  • Injectable drugs that you take every 2 weeks.
  • There are currently two PCSK9 inhibitors – Repatha (Evolocumab) and Praluent (Alirocumab). These are monoclonal antibodies.
  • The PCSK9 protein breaks down the LDL receptors, meaning we have less of them and our blood cholesterol rises. PCSK9 inhibitors stop the protein from working so that we have more LDL receptors on our liver cells and less cholesterol in the blood



  • Injectable which you take every 6 months
  • Inclisiran works in a similar way to another treatment called PCSK9 inhibitors (Evolocumab and Alirocumab) because it blocks the action of a protein called PCSK9.
  • Inclisiran is known as an siRNA, also known as small interfering RNA (RNA interference). It works differently from the PCSK9 inhibitors by interrupting the “printing” of PCSK9 protein from the genetic template known as messenger RNA
  • Clinical trial evidence shows that inclisiran can lower LDL cholesterol levels by at least 50%.


How to lower your cholesterol without drugs (

Discover HEART UK – The Cholesterol Charity


What Is White Coat Hypertension?

Dr Malik Explains White Coat Hypertension Syndrome

In this guide, Dr Malik explains what white coat hypertension is, why it occurs and how LCC’s cardiologists work to overcome these effects.

What is white coat hypertension?

White coat syndrome, also known as white coat hypertension is a phenomenon in which your blood pressure is artificially raised due to the stress of being in a clinic, hospital, or even just taking your own blood pressure. This usually happens due to the stress and anxiety associated with having medical investigations done. Your reading will be higher than it would be if you measured it at home. 

Why does this matter?

On average, the top (systolic) number tends to be about 10mmHg higher in a clinic than at home. The bottom numbers tend to be about 5mmHg. Some people’s blood pressure will be affected more than others –  and if you feel very worried or stressed it could be raised by as much as 30mmHg. This is problematic because it makes it harder for you to get an accurate diagnosis. White coat hypertension isn’t caused by an underlying condition – so it’s crucial we rule this out. 

Where does the term come from?

The term ‘white coat’ refers to the white coats traditionally worn by doctors in years gone by. Doctors who measure your blood pressure will usually be wearing white coats, hence the name! 

How to get an accurate reading?

  • Blood pressure needs to be taken when you are relaxed and have been sitting for a few minutes.
  • If It is high, we may repeat it a few times each with a few minutes gap.  The LOWEST blood pressure reading is the CORRECT one.
  • We might ask you to measure your blood pressure yourself away from the clinic.
  • A 24-hour blood pressure monitor can reveal the White Coat Effect and help get a better average blood pressure reading.

What blood pressure readings indicate white coat hypertension?

If your blood pressure readings are over 140/90mmHg in the clinic (the cut-off for diagnosing high blood pressure) but lower than 140/90mmHg at home – you’re likely being affected by white coat hypertension

Get your accurate blood pressure reading

If you’ve been diagnosed with hypertension (high blood pressure) in the past but suspect it’s due to white coat syndrome – book your 24-hour blood pressure monitoring. You’ll get accurate readings that you simply can’t determine in a clinical setting.