Noel Bairey Merz: The single biggest health threat women face

翻译人员: Emma Zhao 校对人员: wei lu

One out of two of you women

二分之一的女性

will be impacted by cardiovascular disease

一生中会受到心血管疾病

in your lifetime.

的影响。

So this is the leading killer of women.

这是女性的头号杀手。

It's a closely held secret

我不知道为什么

for reasons I don't know.

不为人所知。

In addition to making this personal --

除了针对个人以外--

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

我们要谈论你与你心脏的关系，

and all women's relationship with their heart --

所有女性与心脏的关系--

we're going to wax into the politics.

我们要铸进政治中去。

Because the personal, as you know, is political.

因为个人呢，也是政治化的。

And not enough is being done about this.

在这一点上做得还不够。

And as we have watched women

我们都曾经见过

conquer breast cancer

借助乳腺癌的宣传

through the breast cancer campaign,

女性在征服乳腺癌。

this is what we need to do now with heart.

现在我们也应当这样来对待我们的心脏。

Since 1984,

从1984年以来

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

在美国，女性的死亡率高于男性。

So where we used to think of heart disease

我们那时都习惯认为

as being a man's problem primarily --

心脏病是男性的主要问题-

which that was never true,

其实从来就不正确。

but that was kind of how everybody thought in the 1950s and '60s,

但20世纪五，六十年代人人都这样认为，

and it was in all the textbooks.

并且课本里都是这样的。

It's certainly what I learned when I was training.

我受训的时候就是这样学的。

If we were to remain sexist, and that was not right,

五六十年代那种含有性别歧视色彩的观点是不对的。

but if we were going to go forward and be sexist,

可是，为了讨论这个问题，就让我们站在女性立场上吧。

it's actually a woman's disease.

心脏疾病实际就是女性的疾病。

So it's a woman's disease now.

现在是女性的疾病。

And one of the things that you see

有一件事情你看到的是，

is that male line,

这条男性线上的

the mortality is going down, down, down, down, down.

死亡率一直在下降，下降，下降。

And you see the female line since 1984,

从1984年来，女性这条线，

the gap is widening.

差距在加宽。

More and more women, two, three, four times more women,

越来越多的女性，死于心脏疾病的

dying of heart disease than men.

比男性多两倍，三倍或四倍。

And that's too short of a time period

在这个太短的时间内，

for all the different risk factors that we know

我们有诸多的不同威胁因素

to change.

要改变。

So what this really suggested to us

所以，这就建议我们

at the national level

采取国家级别的

was that diagnostic and therapeutic strategies,

诊断和治疗策略，

which had been developed in men, by men, for men

因为在过去的50年里曾被男性开发，

for the last 50 years --

也为男性服务，

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

它们也起了很好的作用，是不是？

weren't working so well for women.

但，女性们没得到什么好处。

So that was a big wake-up call

那是80年代的

in the 1980's.

一个大警钟。

Heart disease kills more women

无论哪个年龄段，

at all ages

女性的心脏病死亡率

than breast cancer.

都高于乳腺癌。

And the breast cancer campaign --

虽然乳腺癌作了宣传活动，

again, this is not a competition.

但这不是竞争。

We're trying to be as good as the breast cancer campaign.

我们要做像乳腺癌同样好的宣传活动。

We need to be as good as the breast cancer campaign

我们需要做和乳腺癌同样好的活动

to address this crisis.

来解决这场危机。

Now sometimes when people see this,

有时，人们看到这些

I hear this gasp.

就会叹气.

We can all think of someone,

我们可以想到某个人，

often a young woman,

常常是一位很年轻的妇女

who has been impacted by breast cancer.

会受乳腺癌的影响。

We often can't think of a young woman

我们却不会想到一位年轻的妇女

who has heart disease.

会得心脏病。

I'm going to tell you why.

我要告诉大家为什么这样。

Heart disease kills people,

心脏病发作死亡,

often very quickly.

经常很快。

So the first time heart disease strikes in women and men,

所以心脏病第一次袭击男性和女性，

half of the time it's sudden cardiac death --

半数是心源性猝死--

no opportunity to say good-bye,

没机会说再见,

no opportunity to take her to the chemotherapy,

没机会带她去做化疗，

no opportunity to help her pick out a wig.

没机会帮她挑选假发。

Breast cancer,

乳腺癌

mortality is down to four percent.

死亡率下降了4个百分点。

And that is the 40 years

这就是40年来

that women have advocated.

妇女呼吁的结果。

Betty Ford, Nancy Reagan stood up

贝蒂•福特，南希.里根曾经站起来

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

说：“我是乳腺癌的幸存者，”

and it was okay to talk about it.

这是可以谈论的。

And then physicians have gone to bat.

于是，医师们就去着手。

We've done the research.

我们做了调查。

We have effective therapies now.

我们现在拥有有效的疗法。

Women are living longer than ever.

女性比以前更长寿。

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

对待心脏病也应该这样，是时候了。

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

现在还没做什么，是时候了。

We owe an incredible debt of gratitude

我们对这两位女性

to these two women.

欠下感激之债。

As Barbara depicted

就像芭芭拉

in one of her amazing movies, "Yentl,"

在她的一部很棒的电影《燕特尔》“Yentl”里

she portrayed a young woman

刻画了一位年轻的女性

who wanted an education.

想要受教育。

And she wanted to study the Talmud.

她想学习犹太法典。

And so how did she get educated then?

那她怎么样接受的教育呢？

She had to impersonate a man.

她必需得装扮成男人。

She had to look like a man.

她必需看上去像个男人。

She had to make other people believe that she looked like a man

她必需让别人相信她像个男人，

and she could have the same rights

她有男人该有的

that the men had.

同样的权利。

Bernadine Healy, Dr. Healy,

伯纳丁·希利，

was a cardiologist.

希利医师是个心脏病学家。

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

当时是1980年代，

that we saw women and heart disease deaths

我们看到女性心脏病死亡

going up, up, up, up, up,

一直上升，上升，上升,

she wrote an editorial

她在新英格兰医学杂志上

in the New England Journal of Medicine

写了一篇社论，

and said, the Yentl syndrome.

说到燕特尔综合症。

Women are dying of heart disease,

死于心脏病的女性

two, three, four times more than men.

是男性的两倍，三倍或四倍。

Mortality is not going down, it's going up.

死亡率没有下降，而在上升。

And she questioned,

她质疑过，

she hypothesized,

她假设过

is this a Yentl syndrome?

这是一种燕特尔综合症吗？

And here's what the story is.

故事是这样的。

Is it because women don't look like men,

因为女性长的不像男性，

they don't look like that male-pattern heart disease

她们的心脏病不像男性模式，

that we've spent the last 50 years understanding

她们没有我们研究了50年而理解的

and getting really good diagnostics

真正好的诊断

and really good therapeutics,

和真正好的治疗。

and therefore, they're not recognized for their heart disease.

因此，她们的心脏病没被公认。

And they're just passed.

她们就这样走了。

They don't get treated, they don't get detected,

她们没得到医治，她们没被检测，

they don't get the benefit of all the modern medicines.

她们没有得益于所有的现代医药。

Doctor Healy then subsequently became

希利医师后来成为

the first female director

美国国家卫生部的

of our National Institutes of Health.

首位女部长。

And this is the biggest biomedical enterprise research

这是世界上最大的

in the world.

生物医学企业研究。

And it funds a lot of my research.

我的许多研究是由它赞助的。

It funds research all over the place.

它赞助的研究到处都有。

It was a very big deal

她当部长

for her to become director.

是很轰动一时的。

And she started,

她开始的时候，

in the face of a lot of controversy,

面临了许多

the Women's Health Initiative.

对女性健康倡议的争议。

And every woman in the room here

在座的每一位女性

has benefited from that Women's Health Initiative.

都得益于妇女健康倡议。

It told us about hormone replacement therapy.

它告诉我们激素替代疗法。

It's informed us about osteoporosis.

它告诉我们骨质疏松症。

It informed us about breast cancer, colon cancer in women.

它告诉我们女性的乳腺癌，大肠癌。

So a tremendous fund of knowledge

尽管有巨大的知识积累

despite, again,

但还是

that so many people told her not to do it,

有许多人告诉她不要去做，

it was too expensive.

因为它太昂贵了。

And the under-reading was women aren't worth it.

字里行间是说女性不值得。

She was like, "Nope. Sorry. Women are worth it."

她当时说，“不是，抱歉，女性是值得的。”

Well there was a little piece of that Women's Health Initiative

于是有一小部分的妇女健康倡议，

that went to National Heart, Lung, and Blood Institute,

进入到国家心脏，肺和血液研究所

which is the cardiology part of the NIH.

就是国家卫生研究院的心脏学部分。

And we got to do the WISE study --

我们去做的WISE研究--

and the WISE stands for Women's Ischemia Syndrome Evaluation --

WISE代表妇女缺血综合症评估--

and I have chaired this study for the last 15 years.

我已经主持这项研究达15年之久。

It was a study to specifically ask,

这个研究在明确地问，

what's going on with women?

妇女到底怎么了？

Why are more and more women dying

为什么越来越多的女性死于

of ischemic heart disease?

缺铁性心脏病。

So in the WISE, 15 years ago,

15年前，在妇女缺血综合症评估里，

we started out and said, "Well wow, there's a couple of key observations

我们开始说，：“好哇，有几个关键的意见，

and we should probably follow up on that."

我们也许应该跟进观察。”

And our colleagues in Washington, D.C.

在华盛顿特区，

had recently published

我们的同行们最近发表文章，

that when women have heart attacks and die,

把女性和男性

compared to men who have heart attacks and die --

因心脏病致死做了比较--

and again, this is millions of people,

仍有成千上万的人

happening every day --

每天还在发生--

women, in their fatty plaque --

女性在她们的脂肪斑块里

and this is their coronary artery,

这是冠状动脉，

so the main blood supply going into the heart muscle --

主要的血液供应进到心脏肌肉时，

women erode,

女性是受侵蚀式，

men explode.

男性是爆炸式。

You're going to find some interesting analogies

你们会在生理学上找到些

in this physiology.

有趣的相似。

(Laughter)

（笑）

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

我先来描述一下男性模式的心脏病发作。

Hollywood heart attack. Ughhhh.

好莱坞式的心脏病发作。啊。。。

Horrible chest pain.

可怕的胸口痛。

EKG goes pbbrrhh,

心电图一下子跳上去，

so the doctors can see this hugely abnormal EKG.

所以医生看到的是巨大的异常心电图。

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

动脉当中有一个大的血块。

And they go up to the cath lab

他们去到心导管室，

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

嘭嘭嘭就把血块拿掉。

That's a man heart attack.

那是男性的心脏病发作。

Some women have those heart attacks,

有些女性也是这样，

but a whole bunch of women have this kind of heart attack,

但很多的妇女的心脏病发作是，

where it erodes,

动脉受到侵蚀

doesn't completely fill with clot, symptoms are subtle,

但没有完全被血块阻塞，症状不明显，

EKG findings are different --

心电图也不一样--

female-pattern.

这就是女性模式。

So what do you think happens to these gals?

这些女性会怎么样呢？

They're often not recognized, sent home.

经常是，她们没被识别为心脏病发作，而被送回家。

I'm not sure what it was. Might have been gas.

我不清楚是什么。可能是内部有气体。

So we picked up on that

所以我们会注意到，

and we said, "You know, we now have the ability

说，“我们现在有能力

to look inside human beings

用这些特殊的叫做IVUS的管道

with these special catheters called IVUS:

来透视人体内部:

intravascular ultrasound."

血管内超声检查。”

And we said, "We're going to hypothesize

我们说，“我们要假设

that the fatty plaque in women

女性体内的脂肪斑块

is actually probably different,

与男性的不同，

and deposited differently, than men."

并且存积方式也不同。”

And because of the common knowledge

根据男女

of how women and men get fat.

如何变胖的常识。

When we watch people become obese,

当我们看到人发福，

where do men get fat?

男性胖在哪儿呢？

Right here, it's just a focal -- right there.

就在这，就一个焦点--这里。

Where do women get fat?

女性胖到哪儿呢？

All over.

全身都是。

Cellulite here, cellulite here.

这里一块赘肉，这里一团脂肪。

So we said, "Look, women look like they're pretty good

因此我们说：“看哪，女人们很会

about putting kind of the garbage away,

把这些垃圾分散好，

smoothly putting it away.

分得很顺利。

Men just have to dump it in a single area."

男人只能倒进一个地方。”

So we said, "Let's look at these."

我们说，“来看看这些。”

And so the yellow is the fatty plaque,

黄色是脂肪斑块，

and panel A is a man.

A组是男人。

And you can see, it's lumpy bumpy.

你能看到，是波浪不平的。

He's got a beer belly in his coronary arteries.

在他的冠状动脉里长了个啤酒肚。

Panel B is the woman, very smooth.

B组是女性，非常平滑。

She's just laid it down nice and tidy.

她把它摆得整洁漂亮。

(Laughter)

（笑）

And if you did that angiogram,

如果你做过血管造影，

which is the red,

就是这个红色，

you can see the man's disease.

你可以看到男性的疾病。

So 50 years

经过50年的

of honing and crafting these angiograms,

磨练和制作这些血管造影，

we easily recognize

我们很容易认出

male-pattern disease.

男性模式的疾病。

Kind of hard to see that female-pattern disease.

但难于看到女性模式的疾病。

So that was a discovery.

所以，才有了个发现。

Now what are the implications of that?

言外之意是什么呢？

Well once again, women get the angiogram

就是，女性也做血管造影片，

and nobody can tell that they have a problem.

但没有人能告诉她们有问题。

So we are working now on a non-invasive --

我们在着手于一个非侵略性的研究，--

again, these are all invasive studies.

事实上，这些研究都是侵略性的。

Ideally you would love to do all this non-invasively.

最理想的是，你会想用非侵入法来做这些研究。

And again, 50 years

再重复一遍，五十年的

of good non-invasive stress testing,

很好的非侵入的压力测试，

we're pretty good at recognizing male-pattern disease

我们很在行从这些测试中认出

with stress tests.

男性模式的疾病。

So this is cardiac magnetic resonance imaging.

这就是心脏磁共振成像。

We're doing this at the Cedars-Sinai Heart Institute

我们在妇女心脏中心的雪松西奈山心脏中心

in the Women's Heart Center.

做这些研究。

We selected this for the research.

我们为这项研究做了选择。

This is not in your community hospital,

这虽然不是你的社区医院，

but we would hope to translate this.

我们希望能传递相同的信息。

And we're about two and a half years

我们为期5年的研究

into a five-year study.

已进行了一半。

This was the only modality

这是能看到心脏内膜的

that can see the inner lining of the heart.

唯一模式。

And if you look carefully, you can see

如果你仔细看，

that there's a black blush right there.

会看到这里有个黑黑的血块。

And that is microvascular obstruction.

那就是微血管阻塞。

The syndrome, the female-pattern

这种女性模式的症状

now is called microvascular coronary dysfunction, or obstruction.

就叫做冠状动脉微血管功能障碍或阻塞。

The second reason we really liked MRI

我们喜欢核磁共振成像的第二个原因

is that there's no radiation.

是它没有辐射。

So unlike the CAT scans, X-rays, thalliums,

不像计算机辅助测试扫描，X光片，铊扫描等

for women

因为女性

whose breast is in the way

每次做心脏测试

of looking at the heart,

都会考虑对乳房的影响，

every time we order something that has even a small amount of radiation,

哪怕小数量的辐射，

we say, "Do we really need that test?"

我们也会说：“真有做这个测试的必要吗？”

So we're very excited about M.R.

我们对核磁共振非常兴奋。

You can't go and order it yet,

你们还不能现在就去使用它，

but this is an area of active inquiry

但这是个积极探究的领域，

where actually studying women

对女性的研究

is going to advance the field for women and men.

将推进男性和女性的领域。

What are the downstream consequences

女性模式心脏病的

then, when female-pattern heart disease

未被识别的后果

is not recognized?

是如何呢？

This is a figure

这个数据

from an editorial that I published

是从我去年发表在

in the European Heart Journal this last summer.

欧洲心脏杂志上的一片社论来的。

And it was just a pictogram

这个象形图

to sort of show

显示，

why more women are dying of heart disease,

尽管我们知道

despite these good treatments

很多的有效的治疗法，

that we know and we have work.

为什么还有更多的女性死于心脏病。

And when the woman

当女性出现

has male-pattern disease --

男性模式的病症--

so she looks like Barbara in the movie --

就像电影里的芭芭拉一样，

they get treated.

她们才会得到医治。

And when you have female-pattern and you look like a woman,

当你有女性模式的症状，但你看上去也是女性

as Barbara does here with her husband,

就像芭芭拉和她丈夫，

they don't get the treatment.

他们就得不到医治。

These are our life-saving treatments.

这些都是挽救生命的疗法。

And those little red boxes are deaths.

这些小红框子是死亡的。

So those are the consequences.

这些是后果。

And that is female-pattern

那个是女性模式，

and why we think the Yentl syndrome

并且我们认为燕特尔综合症

actually is explaining

也确实解释了

a lot of these gaps.

这些差距。

There's been wonderful news also

对于研究女性方面

about studying women,

有很多好消息，

finally, in heart disease.

最后终于轮到心脏病了。

And one of the the cutting-edge areas

还有一个

that we're just incredibly excited about

让我们异常兴奋的前沿领域

is stem cell therapy.

是干细胞疗法。

If you ask, what is the big difference

如果你问，在生理上

between women and men physiologically?

女性与男性的大的不同之处在哪？

Why are there women and men?

为什么会有女性和男性？

Because women bring new life into the world.

因为女性把新生命带到世上。

That's all stem cells.

这全是干细胞。

So we hypothesized

我们假定

that female stem cells might be better

女性干细胞会很好地

at identifying the injury,

鉴别损伤，

doing some cellular repair

做些细胞修补

or even producing new organs,

或产生新的器官，

which is one of the things

这就是我们正在尝试

that we're trying to do with stem cell therapy.

用干细胞疗法做到的。

These are female and male stem cells.

这就是女性和男性干细胞。

And if you had an injured organ,

如果你的器官受损，

if you had a heart attack

或你心脏病发作，

and we wanted to repair that injured area,

我们想修复受伤的地方，

do you want those robust,

你想不想最先用

plentiful stem cells on the top?

这些强健又足够的干细胞？

Or do you want these guys,

或者，你想他们

that look like they're out to lunch?

这样无精打采呢？

(Laughter)

（笑）

And some of our investigative teams

我们的一些调查团队

have demonstrated

曾展示

that female stem cells --

女性干细胞--

and this is in animals

这是动物的

and increasingly we're showing this in humans --

并且在人类也有增长-

that female stem cells,

就是当我们把女性干细胞

when put even into a male body,

注入男性体内，

do better than male stem cells

它们比男性干细胞

going into a male body.

工作得更好。

One of the things that we say

我们讲的

about all of this female physiology --

女性生理之一

because again, as much as we're talking about women and heart disease,

因为我们在谈论女性与心脏病，

women do, on average,

通常女性

have better longevity than men --

比男性长寿。

is that unfolding the secrets of female physiology

揭示和认识女性的

and understanding that

生理秘密

is going to help men and women.

将会帮助男性和女性。

So this is not a zero-sum game in anyway.

这不是零合的游戏。

Okay, so here's where we started.

好，我们从这里开始。

And remember, paths crossed in 1984,

请记住，交叉点是在1984年，

and more and more women

越来越多的女性

were dying of cardiovascular disease.

死于心脏病。

What has happened in the last 15 years with this work?

在过去的15年里都做了些什么？

We are bending the curve.

这个曲线在打弯。

We're bending the curve.

我们在折弯这条曲线。

So just like the breast cancer story,

就像乳腺癌的故事，

doing research, getting awareness going,

做些调查，让更多人认识到，

it works, you just have to get it going.

它管用的，我们必须继续做下去。

Now are we happy with this?

现在我们满意吗？

We still have two to three more women dying for every man.

女性的死亡率仍是男性的两到三倍。

And I would propose,

那我提议，

with the better longevity

总的来说

that women have overall,

女性比较长寿，

that women probably should theoretically do better,

如果我们女性得到医治，

if we could just get treated.

理论上我们的情况会更好。

So this is where we are,

所以这是我们现在的状况，

but we have a long row to hoe.

更艰巨的在后头。

We've worked on this for 15 years.

我们已经工作了15年。

And I've told you, we've been working on male-pattern heart disease

我也说过，我们在男性心脏病上

for 50 years.

已花了50年的时间。

So we're 35 years behind.

我们落后了35年。

And we'd like to think it's not going to take 35 years.

我们愿意相信，不用再花35年的时间。

And in fact, it probably won't.

事实上也许不会。

But we cannot stop now.

现在不能停步。

Too many lives are at stake.

太多生命处于危险。

So what do we need to do?

我们需要做什么？

You now, hopefully, have a more personal relationship

希望大家跟你的心脏有个

with your heart.

更好的个人关系。

Women have heard the call

女性听到了

for breast cancer

乳腺癌的呼声，

and they have come out

大家就出来

for awareness campaigns.

做宣传活动。

The women are very good about getting mammograms now.

女性都知道做乳房X线照片。

And women do fundraising.

女性做筹款活动。

Women participate.

女性积极参与。

They have put their money where their mouth is

她们省吃俭用

and they have done advocacy and they have joined campaigns.

她们参加宣传，她们参加各种活动。

This is what we need to do with heart disease now.

我们对于心脏病也要这样做。

And it's political.

这是政治。

Women's health, from a federal funding standpoint,

从联邦资金的角度看，

sometimes it's popular,

女性健康有时是受重视，

sometimes it's not so popular.

有时不受重视。

So we have these feast and famine cycles.

这就我们有盛宴和饥荒的循环。

So I implore you

我恳求大家

to join the Red Dress Campaign

去参加红衣活动

in this fundraising.

的筹款。

Breast cancer, as we said,

我们说乳腺癌

kills women,

害死妇女，

but heart disease kills a whole bunch more.

但心脏病害死更多。

So if we can be as good as breast cancer

所以，如果我们能做得像乳腺癌那样好，

and give women this new charge,

给女性新的任务，

we have a lot of lives to save.

我们会拯救很多生命。

So thank you for your attention.

谢谢您的关注。

(Applause)

（掌声）