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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.