and not enough is being done about this and as we have watched women conquer breast cancer through the breast cancercampaign this is what we need to do now with heart
so where we used to think of heart disease as being a man 's problem primarily which that was never true but that was kind of how everybody thought in the one thousand nine hundred and fifty s and sixty s and it was in all the textbooks it 's certainly what i learned when i was training
if we were to remain sexist and that was not right but if we were going to go forward and be sexist it 's actually a woman 's disease so it 's a woman 's disease now
and one of the things that you see is that male line the mortality is going down down down down down and you see the female line since one thousand nine hundred and eighty four the gap is widening more and more women two three four times more women dying of heart disease than men and that 's
too short of a time period for all the different risk factors that we know to change so what this really suggested to us at the national level was that diagnostic and therapeutic strategies which had been developed
in men by men for men for the last fifty years and they work pretty well in men don 't they
and the breast cancercampaign again this is not a competition we 're trying to be as good as the breast cancer campaign
we need to be as good as the breast cancercampaign to address this crisis now sometimes when people see this i hear this gasp
we can all think of someone often a young woman who has been impacted by breast cancer we often can 't think of a young woman who has heart disease
i 'm going to tell you why heart disease kills people often very quickly so the first time heart disease strikes in women and men half of the time it 's sudden cardiac death
no opportunity to say good bye no opportunity to take her to the chemotherapy no opportunity to help her pick out a wig breast cancermortality is down to four percent
and she wanted to study the talmud and so how did she get educated then she had to impersonate a man she had to look like a man she had to make other people believe that she looked like a man and she could have the same rights that
the men had bernadine healy dr healy was a cardiologist
women are dying of heart disease two three four times more than men mortality is not going down it 's going up and she questioned she hypothesized is this a yentl syndrome and here 's what the story is
is it because women don 't look like men they don 't look like that male pattern heart disease that we 've spent the last fifty years
understanding and getting really good diagnostics and really good therapeutics and therefore they 're not recognized for their heart disease and they 're just passed they don 't get treated they don 't get detected they don 't get the benefit of all the modern medicines
doctor healy then subsequently became the first femaledirector of our national institutes of health and this is the biggest biomedical enterpriseresearch in the world and it funds a lot of my research it funds research all over the place it was a very big deal for her to become director
and she started in the face of a lot of controversy the women 's health initiative
and every woman in the room here has benefited from that women 's health initiative it told us about hormone replacement therapy it 's informed us about osteoporosis it informed us about breast cancer colon cancer in women
women aren 't worth it she was like nope sorry women are worth it well there was a little piece of that women 's health initiative that went to national heart lung and blood institute which is the cardiology part of the nih
and we got to do the wise study and the wise stands for women 's ischemia syndrome evaluation and i have chaired this study for the last fifteen years it was a study to specifically ask what 's going on with women why are more and more women dying of ischemic heart disease
so in the wise fifteen years ago we started out and said well wow there 's a couple of key observations and we should probably follow up on that and our colleagues in washington d c had recently published that when women have heart attacks and die
compared to men who have heart attacks and die and again this is millions of people happening every day women in their fatty plaque and this is their coronary artery so the main blood supply going into the heart muscle
women erode men explode
you 're going to find some interesting analogies in this
doesn 't completely fill with clot symptoms are subtle ekg findings are different female pattern so what do you think happens to these gals they 're often not recognized sent home i 'm not sure what it was might have been gas
so we picked up on that and we said you know we now have the ability to look inside human beings with these special catheters called ivus intravascular ultrasound and we said
we 're going to hypothesize that the fatty plaque in women is actually probably different and deposited differently than men
and because of the common knowledge of how women and men get fat when we watch people become obese where do men get fat
right here it 's just a focal right there where do women get fat all over
you can see the man 's disease so fifty years of honing and crafting these angiograms we easily recognize male pattern disease kind of hard to see that female pattern disease so that was a discovery now
what are the implications of that well once again women get the angiogram and nobody can tell that they have a problem so we are working now on a non invasive again these are all invasive studies ideally you would love to do all this non invasively
and again fifty years of good non invasive stress testing we 're pretty good at recognizing male pattern disease with stress tests
so this is cardiac magnetic resonance imaging we 're doing this at the cedars sinai heart institute in the women 's heart center we selected this for the research this is not in your community hospital but we would hope to translate this and we 're about two and a half years into a five year study
this was the only modality that can see the inner lining of the heart and if you look carefully you can see that there 's a black blush right there
and that is microvascular obstruction the syndrome the female pattern now is called microvascular coronary dysfunction or obstruction
the second reason we really liked mri is that there 's no radiation so unlike the cat scans x rays thalliums
is in the way of looking at the heart every time we order something that has even a small amount of radiation we say do we really need that test so we 're very excited about m r you can 't go and order it yet but this is an area of active inquiry where actually studying women is going to advance the field for women and men
what are the downstream consequences then when female pattern heart disease
is not recognized this is a figure from an editorial that i published in the european heart journal this last summer
and it was just a pictogram to sort of show why more women are dying of heart disease despite these good treatments that we know and we have work and when
the woman has male pattern disease so she looks like barbara in the movie they get treated
and when you have female pattern and you look like a woman as barbara does here with her husband they don 't get the treatment these are our life saving treatments and those little red boxes are deaths
so those are the consequences and that is female pattern and why we think the yentl syndrome actually is explaining a lot of these gaps
there 's been wonderful news also about studying women finally in heart disease and one of the the cutting edge areas that we 're just incredibly excited about is stem cell therapy
if you ask what is the big difference between women and men physiologically why are there women and men
because women bring new life into the world
that 's all stem cells so we hypothesized that female stem cells might be better at identifying the injury doing some cellular repair or even producing new organs which is one of the things that we 're trying to do with stem cell therapy
these are female and male stem cells and if you had an injured organ if you had a heart attack and we wanted to repair that injured area do you want those robustplentiful stem cells on the top
or do you want these guys that look like they 're out to lunch laughter and some of our investigative teams have demonstrated that female stem cells and this is in animals and increasingly we 're showing this in humans
that female stem cells when put even into a male body do better than male stem cells going into a male body one of the things that we say about all of this female physiology because again as much as we 're talking about women and heart disease women do on average have better longevity than men
is that unfolding the secrets of female physiology and understanding that is going to help men and women so this is not a zero sum game in anyway
paths crossed in one thousand nine hundred and eighty four and more and more women were dying of cardiovascular disease what has happened in the last fifteen years with this work
we are bending the curve we 're bending the curve
so just like the breast cancer story doing research getting awareness going it works you just have to get it going
now are we happy with this we still have two to three more women dying for every man and i would propose with the
better longevity that women have overall that women probably should theoretically do better if we could just get treated so this is where we are but we have a long row to hoe we 've worked on this for fifteen years and i 've told you we 've been working on male pattern
heart disease for fifty years so we 're thirty five years behind and we 'd like to think it 's not going to take thirty five years and in fact it probably won 't but we cannot stop now too many lives are at stake
so what do we need to do you now hopefully have a more personal relationship with your heart women have
so i implore you to join the red dress campaign in this fundraising
生词表: