i'm here to talk about the facts. the facts. heart disease kills more womenthan all cancers combined. 4% of women are diagnosedwith breast cancer annually whereas 44% of womenare diagnosed with heart disease. even though heart diseasehas been called a man's disease, since 1984, more women have diedannually from heart disease than men. in the us, 39,520 women diedof breast cancer last year but nearly 500,000 womendied from heart disease.
put another way, in worldwide figures about 400,000 womendied from breast cancer but 8,6 million womendied from heart disease. given these statisticsonly 24% of participants in all heart-related studies are women. for 50 years, women have been treatedbased on diagnostics created for men. and surveys of available data show that a very small percentageof research dollars spent in the us focus on the treatmentof women with heart disease.
so what is wrong with this picture? what is wrong with this pictureis the outrageous gender inequality that women facein the treatment of heart disease. i consider myselfa well informed person, sort of (giggles) but when i heardthese facts, i was stunned. very few people seem to know this and until recently, almost no one talked aboutor paid attention to an epidemic
that women are dying fromthroughout the world. women have made enormous strides. we have had women explorethe depths of outer space, a woman has run for president of the us, and a woman has servedas a speaker of the house. yet, a boys' club still existsin the medical sciences. when i learned this,i knew i had to get involved and try to do somethingto change this picture. i believe that those with a platformin the entertainment industry
have the privilege of being able to speak out against inequality,discrimination and injustice. and that's why i have chosento speak out on this issue. the number of womendying from breast cancer has significantly declined over the years because of people speaking out,sharing their stories, and the enormous amount of money that is raised for researchand early detection efforts. last year, an estimated $1.7 billionwas raised for breast cancer alone,
and that's great. but only a small fraction of that amountwas raised for women's heart disease. we desperately need the same kindof coordinated campaign. so, in 2008, i endowed a researchand education programme at cedars-sinai women's heart center under the leadershipof dr. noel bairey merz who was doinglife-saving work in this field. throughout my life, gender inequalityhas always concerned me, whether it is making a movie about itor becoming involved in women's issues.
and in this case gender really does matterwhen it comes to medical science. how can you treat a womanfor a life-threatening ailment based on research done on men? especially when women's hearts are physiologically differentthan men's hearts? women tend to have blockages,not only in their main arteries but also in the smaller arteriesthat supply blood to the heart, a condition called microvascular disease, and you will hear moreabout that from dr merz.
because of this, heart disease presentsvery differently in women than in men. 71% of women experienceearly warning signs of a heart attack with sudden onset of extreme weaknessthat feels like the flu, often with no chess pain at all,unlike the hollywood heart attack we are all accustomed to seeingin movies and television where the man grips his chestand falls to the floor. most women who haveheart attack experience nausea, vomiting, sweating, and light-headedness. nearly twp thirds of the deathsfrom heart attacks in women occur
among those who haveno history of chest pain. most women do not knowthis and often times, by the time they enter the emergency room, their hearts have sufferedsubstantial damage. even if they go to their doctorwho is well-intentioned, they are often misdiagnosed. i have met patients who have consultedtwo or three cardiologists and they are still misdiagnosed because many doctorsare not given the proper training
to know the warning signs in women. heart research done on womenalso helps men as well. take stem cell research for example. recently, dr. merz and i were talkingabout the work of a colleague who was trying to growthe first human heart in a petri dish. she had a breakthroughin her study when she found out that using only female stem cellswas the solution. (laughter) how powerful is that, girls?
(applause) because she discoveredthat using male stem cells did not work. they got totally lost. this is true. and as we know, men, evenmale stem cells, won't ask for directions. it's true. funny but true! so, joking aside,the heart is an amazing organ. and first and foremost,we need to focus on prevention. women's lives are becomingincreasingly demanding
as they juggle the responsibilitiesof being wife, mother, and helping to support the family. we need to take better care of ourselves. we need to slow down, reduce stress,eat better, make time for exercise. because the heart is a precious organthat needs to be protected. recently, i read an article authoredby sociology professor mitch hall. and i found that his insights, which are reinforcedby various academic sources are really fascinating.
so, i am going to quote a few here. he wrote: "as we develop in the utero, the human heart isthe first organ to begin forming. in traditional chinese medicine,the inner spiritual core of the self is deemed to residenot in the head but in the heart." he goes on to say: "the heartis not just pump, what it does is listen." he suggests that: "the heart sensesand integrates our thoughts, our emotions and our will to carry out tasks. the heart actually is a sensitiveintegrator of all our experience.
ancient cultures saw the heartas the seed of the soul. a human being has dual hearts, the first, a pulsating fistof muscle in the chest, the second, a precious cabalof communicating neurons that create feeling, longing and love. many idioms attest to this second heart,the social emotional heart. for instance, sorrow is 'heartbreak, 'sincere intentions are 'heart-felt.' compassionate is to be 'open-hearted'devoid of compassion, 'heartless, ' to 'follow one's heart' means to acton the basis of an intuitive sense
of one's own most fulfilling option." he closes by saying:"to hearten is to 'encourage, ' and our english word 'courage' is itself derived from the french word'coeur, ' meaning heart." which brings me to the reasoni am here today, to introduce a womanwith a big one, a big heart that is! and a thin body! [i am] envious. dr. noel bairey merz!
she is the directorof women's heart center at cedars-sinai and is helping to lead the way enclosing the 50-year research gapin women's heart disease. she is a harvard medical school graduate, has publishedover 180 specific publications and has receivednumerous awards recognizing her as one of the field's leading expertson preventive cardiology, women's heart disease and mental stress. she is an amazing woman who can jugglea hundred different things all at once
and still have time to raisea beautiful family. i was thrilled when i heard that this brilliant womanwas doing life-saving work that would ultimately impactwomen all over the world, right in our own backyard hereat cedars-sinai medical center. we can no longer afford to naively assumethat heart disease is only a men's disease because as i mentioned earlier,it's now an epidemic facing women. so, i want to thank dr merzfor the work she is doing to help women livelonger and healthier lives,
women we love, our mothers, daughters, sisters, aunts, wives, and friends. and with that, it's my honor to introduce the remarkable dr. noel bairey merz! (music) [relationships] noel bairey merz: thank youso much and thank you barbara. as usual, your leadership in our worktogether is clearly saving lives. i am here in this sessionabout relationships to talk about your relationshipwith your heart.
and too often, womenare not thinking about their hearts, so it's a critically importantrelationship. look to your left, look to your right. one out of two of you womenwill be impacted by cardiovascular diseasein your life-time. so, this is the leading killer of women. it is a closely-held secretfor reasons i do not know. as you know i am a cardiologist. in addition to making this personal,
so we are going to talk aboutyour relationship with your heart and all women's relationshipswith their heart, we are going to wax into the politicsbecause the personal is political. and not enoughis being done about this and as we have watched womenconquer breast cancer, through the breast cancer campaign, this is what we need to do now with heart. so, from since 1984, more women now die in the us than men
so where we used to think of heart diseaseas being a men's problem primarily, which was never true but that was kind ofhow everybody thought in the 1950s and 60s and it was in all the textbooks, it is certainly what i learnedwhen i was training. it is actually a woman's disease. so it is a woman's disease now. and one of the thingsthat you see is that male line, the mortality is going down, and you see the female linesince 1984, 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 factorsthat we know, to change. so what this really suggestedto us at a national level was that diagnosticand therapeutic strategies which had been developed in men,by men, for men for the last 50 years and they work pretty wellin men, don't they? were not working so well for women!
so that was a big wake-up callin the 1980s! heart disease kills more women,at all ages, than breast cancer. and the breast cancer campaignagain, this is not a competition, we are trying to be as goodas the breast cancer campaign, we need to be as good as the breast cancercampaign to address this crisis. now, sometimes when peoplesee this, i hear this gasp. we can all think of someone,often a young woman who has been impacted by breast cancer. we often cannot think of a young womanwho has heart disease.
i am going to tell you why! heart disease kills people,often very quickly. so the first time heart diseasestrikes in women and men, but we are talking about women today, half of the time,it is sudden cardiac death. no opportunity to say goodbye, no opportunity to take herto the chemotherapy, no opportunity to help her pick out a wig. [in] breast cancer,mortality is down to 4%
and that is the 40 yearsthat women have advocated. betty ford, nancy reagan stood upand said i am a breast cancer survivor and it was ok to talk about itand then physicians have gone to the bed. we have done the research.we have effective therapies now. women are living longer than ever. that has to happenin heart disease, and it is time. it is not happening and it is time. we owe an incredible debtand gratitude to these two women. i know i got another web.
as barbara depicted in oneof her amazing movies 'yentl', in order to get treated like a man, she portrayed a young womanwho wanted an education. she wanted to study the talmud. 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 peoplebelieve that she looked like a man and that she could havethe same rights that the man had.
bernardine healy,dr. healy is a cardiologist and right around that time, in the 1980s, that we saw womenand heart disease deaths going up and up, she wrote an editorial in the new englandjournal of medicine and said "the yentl syndrome" [that's] women are dying of heart diseasetwo, three, four times more than men. mortality is not going down,it's going up, and she hypothesized"is this a yentl syndrome?" and here is what the story is.
it is because women don't looklike men, they don't look like that male pattern heart disease that we have spent the last50 years understanding and getting really good diagnosticsand really good therapeutics. and therefore, they are not recognisedfor their heart disease and they just pass. they do not get treated,they do not get detected, they do not get the benefitof all the modern medicine. dr heale then subsequentlybecame the first female director
of our national institutes of health. and this is the biggest biomedicalenterprise research in the world. it funds a lot of my research.it funds research all over the place. it was a very big dealfor her to become director. in the face of a lot of controversy,she started the women's health initiative. every woman in the room here has benefitedfrom that woman's health initiative. it told us about hormonereplacement therapy, it has informed us about osteoporosis,breast cancer and colon cancer in women. tremendous fundof knowledge despite, again,
that so many peopletold her not to do it. it was too expensive and the underwritingwas [that] women are not worth it. she was like:"no, sorry.women are worth it." was a little pieceof that women's health initiative that went to national heart,lung and blood institute, which is the cardiology part of the nihand we got to do the wise study and it stands for women'sischemia syndrome evaluation, and i have chaired this studyfor the last 15 years. it was the study to specifically ask"what's going on with women?"
why are more and more women dyingof ischemic heart disease? so, in the wise, 15 years ago,we started out and said [that]there's a couple of key observationsand we should probably follow up on that. and our colleaguesin washington dc had recently published that when womenhave heart attacks and die, compared to menwho have heart attacks and die, and again, this is millionsof people; happening everyday, women in their fatty plaque,and this is their coronary arteries [where] the main blood supply[is] going into the heart muscle
women erode, men explode. you are going to find someinteresting analogies in this physiology. i will describe the male patternheart attack first, the hollywood heart attack, ahhhh! horrible chest pain, ekg goes boom! so the doctors can seethis hugely abnormal ekg. there's a big clotin the middle of the artery and they go up to the cath laband boom! boom! boom! get rid of the clot. that's a man's heart attack.
some women have those heart attacksbut a whole bunch of women have this kind of heart attack where the roads[do] not completely fill with clot. symptoms are subtle,ekg findings are different. female pattern. so what do you thinkhappens to these girls? they are often not recognised, sent home. i am not sure what it was.it might have been gas. so, we picked up on that and said[that] we now have the ability
to look inside human beingswith special catheters called ivus, intravascular ultrasound. and we said we are going to hypothesizethat the fatty plaque in women is actually probably differentand deposited differently than men. and because of the common knowledgeof how women and men get fat when we watch people become obese,where do men get fat? right here. it is just a focal...right there! where do women get fat? all over! cellulite here, cellulite here!
so, women look like they are pretty goodabout putting the garbage away smoothly putting it away. men just have to dump it in a single area. so we said, let's look at this,and so the yellow is the fatty plaque, and panel a is a manand you can see it is lumpy bumpy. he has got a beer bellyin his coronary arteries. panel b is the woman, very smooth,she has just laid it down, nice and tidy. if you did that angiogram which isthe red you can see the man's disease. so 50 years of honingand crafting these angiograms,
we easily recognize male pattern disease. it is kind of hard to seethat female pattern disease! so that was a discovery,and what are the implications of that? once again, women get the angiogram andnobody can tell that they have a problem. so, we are working now on non-invasive...- again, these are all invasive studies, ideally you would loveto do all this non-invasively. and again, 50 years of good non-invasivestress testing were pretty good at recognizing male patterndisease with stress tests. this iscardiac magnetic resonance imaging.
we're doing this at the cedars-sinai heartinstitute in the women's heart center. we selected this for the research. this is not in your community hospitalbut we would hope to translate this, an about 2.5 years into a 5-year study. this was the only modality that can seethe inner lining of the heart. if you look carefully you can seethat there is a black lash right there and that is macrovascular obstruction. the syndrome, the female pattern is called microvascular coronary dysfunctionor obstruction.
the second reason we really like the mriis that there is no radiation. so, unlike the cat scans, xrays, thalliums for women whose breast isin the way of looking at the heart, every time we order somethingthat has even a small amount of radiation, we say "do we really need that test?" so we are very excited about mr. you cannot go and order it yetbut this is an area of active inquiry, where actually studying women is goingto advance the field for women and men. what are the consequences?
we got these from barbara. you approved it. then, what are the downstream consequences when female pattern heart diseaseis not recognised? this is a figure froman editorial that i published in the european heart journalthis last summer and it was just a pictogram, to show why more womenare dying of heart disease despite these good treatmentsthat we know and we have worked?
when the woman has male pattern disease, so she looks like barbara in the movie, they get treated. and when you have female patternand you look like a woman, as barbara does here with her husband, they do not get the treatment,these are our life-saving treatments and those little red boxes are deaths. so [those are] the consequencesand that is female pattern and why we think the yentl syndromeis in fact explaining a lot of these gaps.
there has been wonderful newsalso about studying women, finally, in heart disease! one of the cutting edge areasthat we are just incredibly excited about is stem cell therapy. women, you might imagine, if you ask, 'what is the big difference betweenwomen and men physiologically?' why are there women and men? because women bringnew life into the world. men don't. they participate, sort of.
but [only] women can generatea new life and can remodel, can put the garbage where it needs to be, makes a new thing,new baby, baby comes out. and that is all stem cells. so, we hypothesize that female stem cells might be better at identifyingthe injury, doing some cellular repair, or even producing new organs, which isone of the things that we are trying to do with stem cell therapy. these are female and male stem cells.
if you had an injured organ,if you had a heart attack, and we wanted to repair that injured area, do you want those robust,plentiful stem cells on the top? or do you want these guysthat look like they are out to lunch? some of our investigative teamshad demonstrated that female stem cells and this is in animals,and increasingly in humans that female stem cells, when puteven into a male body, do better than male stem cells into a male body. one of the things that we say aboutall of this female physiology,
because again as much as we are talkingabout women and heart disease, women do, on average,have better longevity than men, is that the unfolding the secretsof female physiology and understanding that,is going to help men and women. so this is not a zero sum scam in any way. so here is where we startedand remember, paths crossed in 1984 and more and more womenwere dying of cardiovascular disease. what has happenedin the last 15 years with this work? we are bending the curb.
so, just like the breast cancer story,doing research, getting awareness going, it works, you just have to get it going! are we happy with this? we still have two to threemore women dying for every man. and i'd propose with the better longevitythat women have overall that just making this equal, i think,is probably not going to be the truth women probably should, theoretically,do better, if we could just get treated. so, this is where we arebut we have a long row to hoe. we have worked on thisfor 15 years, and i have told you,
we have been working on male patternheart disease for 50 years. so we are 35 years behind and we'd liketo think it is not going to take 35 years and in fact it probably won't. but we cannot stop now.too many lives are at stake. what do we need to do? you now, hopefully, have a morepersonal relationship with your heart. women have heardthe call for breast cancer and they have come outfor awareness campaigns; that women are very good at gettingmammograms now and they do fund raising.
women participate. they have put their moneywhere their mouth is, and they have done advocacyand they have joined campaigns. this is what we need to dowith heart disease and it is political. women's healthfrom a federal funding standpoint, sometimes is popular,sometimes it is not so popular. so we have these feast and famine cycles. so i implore you to jointhe red dress campaign there is the heart truthwhich is the red dress.
go get a pin and you can get themfrom our women's heart center from national heart lung andblood over the american heart. please join barbara in this fund raising. we need to be as good,if not better, than breast cancer. breast cancer, as we said, kills women but heart disease killsa whole bunch more. so if we can be as good as breast cancerand give women this new charge we have a lot of lives to save. so, thank you for your attention.
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