Noel Bairey Merz: The single biggest health threat women face

64,640 views ・ 2012-03-21

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00:15
One out of two of you women
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will be impacted by cardiovascular disease
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in your lifetime.
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So this is the leading killer of women.
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It's a closely held secret
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for reasons I don't know.
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In addition to making this personal --
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so we're going to talk about your relationship with your heart
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and all women's relationship with their heart --
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we're going to wax into the politics.
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Because the personal, as you know, is political.
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And not enough is being done about this.
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And as we have watched women
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conquer breast cancer
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through the breast cancer campaign,
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this is what we need to do now with heart.
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Since 1984,
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more women die in the U.S. than men.
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So where we used to think of heart disease
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as being a man's problem primarily --
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which that was never true,
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but that was kind of how everybody thought in the 1950s and '60s,
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and it was in all the textbooks.
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It's certainly what I learned when I was training.
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If we were to remain sexist, and that was not right,
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but if we were going to go forward and be sexist,
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it's actually a woman's disease.
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So it's a woman's disease now.
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And one of the things that you see
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is that male line,
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the mortality is going down, down, down, down, down.
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And you see the female line since 1984,
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the gap is widening.
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More and more women, two, three, four times more women,
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dying of heart disease than men.
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And that's too short of a time period
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for all the different risk factors that we know
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to change.
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So what this really suggested to us
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at the national level
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was that diagnostic and therapeutic strategies,
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which had been developed in men, by men, for men
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for the last 50 years --
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and they work pretty well in men, don't they? --
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weren't working so well for women.
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So that was a big wake-up call
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in the 1980's.
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Heart disease kills more women
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at all ages
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than breast cancer.
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And the breast cancer campaign --
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again, this is not a competition.
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We're trying to be as good as the breast cancer campaign.
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We need to be as good as the breast cancer campaign
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to address this crisis.
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Now sometimes when people see this,
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I hear this gasp.
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We can all think of someone,
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often a young woman,
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who has been impacted by breast cancer.
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We often can't think of a young woman
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who has heart disease.
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I'm going to tell you why.
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Heart disease kills people,
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often very quickly.
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So the first time heart disease strikes in women and men,
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half of the time it's sudden cardiac death --
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no opportunity to say good-bye,
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no opportunity to take her to the chemotherapy,
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no opportunity to help her pick out a wig.
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Breast cancer,
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mortality is down to four percent.
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And that is the 40 years
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that women have advocated.
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Betty Ford, Nancy Reagan stood up
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and said, "I'm a breast cancer survivor,"
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and it was okay to talk about it.
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And then physicians have gone to bat.
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We've done the research.
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We have effective therapies now.
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Women are living longer than ever.
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That has to happen in heart disease, and it's time.
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It's not happening, and it's time.
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We owe an incredible debt of gratitude
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to these two women.
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As Barbara depicted
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in one of her amazing movies, "Yentl,"
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she portrayed a young woman
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who wanted an education.
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And she wanted to study the Talmud.
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And so how did she get educated then?
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She had to impersonate a man.
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She had to look like a man.
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She had to make other people believe that she looked like a man
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and she could have the same rights
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that the men had.
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Bernadine Healy, Dr. Healy,
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was a cardiologist.
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And right around that time, in the 1980's,
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that we saw women and heart disease deaths
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going up, up, up, up, up,
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she wrote an editorial
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in the New England Journal of Medicine
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and said, the Yentl syndrome.
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Women are dying of heart disease,
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two, three, four times more than men.
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Mortality is not going down, it's going up.
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And she questioned,
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she hypothesized,
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is this a Yentl syndrome?
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And here's what the story is.
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Is it because women don't look like men,
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they don't look like that male-pattern heart disease
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that we've spent the last 50 years understanding
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and getting really good diagnostics
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and really good therapeutics,
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and therefore, they're not recognized for their heart disease.
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And they're just passed.
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They don't get treated, they don't get detected,
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they don't get the benefit of all the modern medicines.
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Doctor Healy then subsequently became
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the first female director
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of our National Institutes of Health.
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And this is the biggest biomedical enterprise research
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in the world.
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And it funds a lot of my research.
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It funds research all over the place.
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It was a very big deal
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for her to become director.
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And she started,
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in the face of a lot of controversy,
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the Women's Health Initiative.
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And every woman in the room here
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has benefited from that Women's Health Initiative.
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It told us about hormone replacement therapy.
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It's informed us about osteoporosis.
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It informed us about breast cancer, colon cancer in women.
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So a tremendous fund of knowledge
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despite, again,
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that so many people told her not to do it,
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it was too expensive.
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And the under-reading was women aren't worth it.
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She was like, "Nope. Sorry. Women are worth it."
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Well there was a little piece of that Women's Health Initiative
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that went to National Heart, Lung, and Blood Institute,
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which is the cardiology part of the NIH.
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And we got to do the WISE study --
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and the WISE stands for Women's Ischemia Syndrome Evaluation --
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and I have chaired this study for the last 15 years.
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It was a study to specifically ask,
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what's going on with women?
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Why are more and more women dying
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of ischemic heart disease?
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So in the WISE, 15 years ago,
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we started out and said, "Well wow, there's a couple of key observations
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and we should probably follow up on that."
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And our colleagues in Washington, D.C.
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had recently published
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that when women have heart attacks and die,
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compared to men who have heart attacks and die --
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and again, this is millions of people,
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happening every day --
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women, in their fatty plaque --
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and this is their coronary artery,
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so the main blood supply going into the heart muscle --
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women erode,
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men explode.
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You're going to find some interesting analogies
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in this physiology.
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(Laughter)
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So I'll describe the male-pattern heart attack first.
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Hollywood heart attack. Ughhhh.
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Horrible chest pain.
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EKG goes pbbrrhh,
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so the doctors can see this hugely abnormal EKG.
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There's a big clot in the middle of the artery.
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And they go up to the cath lab
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and boom, boom, boom get rid of the clot.
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That's a man heart attack.
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Some women have those heart attacks,
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but a whole bunch of women have this kind of heart attack,
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where it erodes,
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doesn't completely fill with clot, symptoms are subtle,
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EKG findings are different --
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female-pattern.
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So what do you think happens to these gals?
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They're often not recognized, sent home.
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I'm not sure what it was. Might have been gas.
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So we picked up on that
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and we said, "You know, we now have the ability
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to look inside human beings
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with these special catheters called IVUS:
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intravascular ultrasound."
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And we said, "We're going to hypothesize
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that the fatty plaque in women
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is actually probably different,
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and deposited differently, than men."
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And because of the common knowledge
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of how women and men get fat.
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When we watch people become obese,
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where do men get fat?
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Right here, it's just a focal -- right there.
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Where do women get fat?
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All over.
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Cellulite here, cellulite here.
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So we said, "Look, women look like they're pretty good
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about putting kind of the garbage away,
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smoothly putting it away.
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Men just have to dump it in a single area."
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So we said, "Let's look at these."
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And so the yellow is the fatty plaque,
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and panel A is a man.
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And you can see, it's lumpy bumpy.
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He's got a beer belly in his coronary arteries.
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Panel B is the woman, very smooth.
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She's just laid it down nice and tidy.
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(Laughter)
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And if you did that angiogram,
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which is the red,
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you can see the man's disease.
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So 50 years
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of honing and crafting these angiograms,
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we easily recognize
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male-pattern disease.
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Kind of hard to see that female-pattern disease.
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So that was a discovery.
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Now what are the implications of that?
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Well once again, women get the angiogram
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and nobody can tell that they have a problem.
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So we are working now on a non-invasive --
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again, these are all invasive studies.
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Ideally you would love to do all this non-invasively.
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And again, 50 years
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of good non-invasive stress testing,
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we're pretty good at recognizing male-pattern disease
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with stress tests.
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So this is cardiac magnetic resonance imaging.
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We're doing this at the Cedars-Sinai Heart Institute
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in the Women's Heart Center.
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We selected this for the research.
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This is not in your community hospital,
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but we would hope to translate this.
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And we're about two and a half years
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into a five-year study.
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This was the only modality
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that can see the inner lining of the heart.
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And if you look carefully, you can see
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that there's a black blush right there.
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And that is microvascular obstruction.
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The syndrome, the female-pattern
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now is called microvascular coronary dysfunction, or obstruction.
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The second reason we really liked MRI
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is that there's no radiation.
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So unlike the CAT scans, X-rays, thalliums,
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for women
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whose breast is in the way
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of looking at the heart,
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every time we order something that has even a small amount of radiation,
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we say, "Do we really need that test?"
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So we're very excited about M.R.
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You can't go and order it yet,
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but this is an area of active inquiry
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where actually studying women
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is going to advance the field for women and men.
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What are the downstream consequences
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then, when female-pattern heart disease
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is not recognized?
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This is a figure
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from an editorial that I published
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in the European Heart Journal this last summer.
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And it was just a pictogram
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to sort of show
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why more women are dying of heart disease,
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despite these good treatments
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that we know and we have work.
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And when the woman
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has male-pattern disease --
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so she looks like Barbara in the movie --
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they get treated.
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And when you have female-pattern and you look like a woman,
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as Barbara does here with her husband,
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they don't get the treatment.
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These are our life-saving treatments.
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And those little red boxes are deaths.
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So those are the consequences.
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And that is female-pattern
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and why we think the Yentl syndrome
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actually is explaining
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a lot of these gaps.
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There's been wonderful news also
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about studying women,
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finally, in heart disease.
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And one of the the cutting-edge areas
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that we're just incredibly excited about
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is stem cell therapy.
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If you ask, what is the big difference
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between women and men physiologically?
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Why are there women and men?
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Because women bring new life into the world.
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That's all stem cells.
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So we hypothesized
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that female stem cells might be better
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at identifying the injury,
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doing some cellular repair
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or even producing new organs,
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which is one of the things
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that we're trying to do with stem cell therapy.
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These are female and male stem cells.
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And if you had an injured organ,
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if you had a heart attack
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and we wanted to repair that injured area,
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do you want those robust,
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plentiful stem cells on the top?
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Or do you want these guys,
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that look like they're out to lunch?
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(Laughter)
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And some of our investigative teams
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have demonstrated
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that female stem cells --
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and this is in animals
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and increasingly we're showing this in humans --
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that female stem cells,
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when put even into a male body,
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do better than male stem cells
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going into a male body.
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One of the things that we say
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about all of this female physiology --
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because again, as much as we're talking about women and heart disease,
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women do, on average,
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have better longevity than men --
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is that unfolding the secrets of female physiology
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and understanding that
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is going to help men and women.
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So this is not a zero-sum game in anyway.
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Okay, so here's where we started.
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And remember, paths crossed in 1984,
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and more and more women
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were dying of cardiovascular disease.
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What has happened in the last 15 years with this work?
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We are bending the curve.
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We're bending the curve.
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So just like the breast cancer story,
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doing research, getting awareness going,
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it works, you just have to get it going.
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Now are we happy with this?
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We still have two to three more women dying for every man.
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And I would propose,
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with the better longevity
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that women have overall,
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that women probably should theoretically do better,
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if we could just get treated.
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So this is where we are,
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but we have a long row to hoe.
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We've worked on this for 15 years.
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And I've told you, we've been working on male-pattern heart disease
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for 50 years.
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So we're 35 years behind.
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And we'd like to think it's not going to take 35 years.
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And in fact, it probably won't.
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But we cannot stop now.
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Too many lives are at stake.
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So what do we need to do?
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You now, hopefully, have a more personal relationship
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with your heart.
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Women have heard the call
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for breast cancer
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and they have come out
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for awareness campaigns.
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The women are very good about getting mammograms now.
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And women do fundraising.
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Women participate.
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They have put their money where their mouth is
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and they have done advocacy and they have joined campaigns.
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This is what we need to do with heart disease now.
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And it's political.
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Women's health, from a federal funding standpoint,
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sometimes it's popular,
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sometimes it's not so popular.
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So we have these feast and famine cycles.
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So I implore you
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to join the Red Dress Campaign
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in this fundraising.
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Breast cancer, as we said,
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kills women,
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but heart disease kills a whole bunch more.
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So if we can be as good as breast cancer
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and give women this new charge,
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we have a lot of lives to save.
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So thank you for your attention.
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(Applause)
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