will be impacted by cardiovascular disease

in your lifetime.

So this is the leading killer of women.

It's a closely held secret

for reasons I don't know.

In addition to making this personal --

so we're going to talk about your relationship with your heart

and all women's relationship with their heart --

we're going to wax into the politics.

Because the personal, as you know, is political.

And not enough is being done about this.

And as we have watched women

conquer breast cancer

through the breast cancer campaign,

this is what we need to do now with heart.

Since 1984,

more women die in the U.S. than men.

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 1950s and '60s,

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 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 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 50 years --

and they work pretty well in men, don't they? --

weren't working so well for women.

So that was a big wake-up call

in the 1980's.

Heart disease kills more women

at all ages

than breast cancer.

And the breast cancer campaign --

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 cancer campaign

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 cancer,

mortality is down to four percent.

And that is the 40 years

that women have advocated.

Betty Ford, Nancy Reagan stood up

and said, "I'm a breast cancer survivor,"

and it was okay to talk about it.

And then physicians have gone to bat.

We've done the research.

We have effective therapies now.

Women are living longer than ever.

That has to happen in heart disease, and it's time.

It's not happening, and it's time.

We owe an incredible debt of gratitude

to these two women.

As Barbara depicted

in one of her amazing movies, "Yentl,"

she portrayed a young woman

who wanted an education.

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.

And right around that time, in the 1980's,

that we saw women and heart disease deaths

going up, up, up, up, up,

she wrote an editorial

in the New England Journal of Medicine

and said, the Yentl syndrome.

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 50 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 female director

of our National Institutes of Health.

And this is the biggest biomedical enterprise research

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.

So a tremendous fund of knowledge

despite, again,

that so many people told her not to do it,

it was too expensive.

And the under-reading was 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 15 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, 15 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 physiology.

(Laughter)

So I'll describe the male-pattern heart attack first.

Hollywood heart attack. Ughhhh.

Horrible chest pain.

EKG goes pbbrrhh,

so the doctors can see this hugely abnormal EKG.

There's a big clot in the middle of the artery.

And they go up to the cath lab

and boom, boom, boom get rid of the clot.