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One out of two of you women
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.