Noel Bairey Merz: The single biggest health threat women face

譯者: Ting-Yu CHU 審譯者: Joan Liu

One out of two of you women

在座的女性，有二分之一的妳們

will be impacted by cardiovascular disease

在妳們的一生當中

in your lifetime.

將會遭受到心臟血管疾病

So this is the leading killer of women.

所以我們可以說它是女性的頭號殺手

It's a closely held secret

但這卻是一個沒有被公開秘密

for reasons I don't know.

我也不知道為什麼

In addition to making this personal --

除了讓這個訊息涉及到每一個人身上以外

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

我們當然會先討論妳和妳心臟之間的關係

and all women's relationship with their heart --

還有所有女性與她們心臟之間的關係

we're going to wax into the politics.

接著，我們還要把它擴及到政治上面

Because the personal, as you know, is political.

畢竟，涉及個人私事的事情，通常也都是政治化的

And not enough is being done about this.

至今人們對此做的還不夠

And as we have watched women

但因為我們都曾經看過

conquer breast cancer

看過女性在乳癌相關活動中

through the breast cancer campaign,

戰勝乳癌的例子

this is what we need to do now with heart.

這就是現階段我們必須要對心臟做的事情

Since 1984,

自從1984年以來

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

在美國女性因為心臟疾病死亡的人數大於男性

So where we used to think of heart disease

過去我們一直認為

as being a man's problem primarily --

「心血管疾病主要是男性的疾病」

which that was never true,

其實一直都不是真的

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

但在1950、60的年代，幾乎所有人都這麼覺得

and it was in all the textbooks.

連教科書上也都這麼說

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

可以肯定的是在我就學階段我是這樣被教育的

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

如果我們是想要維持性別主義的話，那這個論點是錯的

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

但如果我們想要有所進步並且同時維持性別主義的話

it's actually a woman's disease.

心血管疾病其實是女性的疾病

So it's a woman's disease now.

所以，這現在是女性的疾病了

And one of the things that you see

你們可以發現一件事

is that male line,

在男性的趨勢線上面

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

死亡率一直不斷的下降，下降，下降

And you see the female line since 1984,

接著再看到1984年以來的女性死亡率

the gap is widening.

與男性的差距不斷擴大

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

越來越多的女性，以兩倍到三倍到四倍

dying of heart disease than men.

的差距遠勝於男性因心臟疾病的死亡率

And that's too short of a time period

而在那麼短的時間內

for all the different risk factors that we know

據我們所知，就算所有的危險因子加在一起

to change.

也不足以做出改變

So what this really suggested to us

所以，這個圖表真正帶給我們的啟發是

at the national level

以整體而言

was that diagnostic and therapeutic strategies,

在過去五十年來

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

所有國內的診斷和治療策略

for the last 50 years --

都是在男性身上，並且針對男性而發明的

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

而且也都還滿有效的，對吧?

weren't working so well for women.

但對於女性來說就沒這麼有效了

So that was a big wake-up call

所以，在80年代的時候

in the 1980's.

這個數據喚起了大家的重視

Heart disease kills more women

那就是，心臟疾病對各個女性朋友們的年齡層來說

at all ages

都比乳癌

than breast cancer.

來得致命

And the breast cancer campaign --

關於乳癌防治推廣運動

again, this is not a competition.

當然，這不是競賽

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

我們試著要做得跟乳癌防治運動一樣好

We need to be as good as the breast cancer campaign

我們必須要做得跟乳癌防治運動一樣好

to address this crisis.

才可以對付這個危機

Now sometimes when people see this,

有時候當人們看見這個圖表的時候

I hear this gasp.

我會聽見倒吸氣的聲音

We can all think of someone,

我們常常都可以聯想到某個人

often a young woman,

經常是一位年輕女性

who has been impacted by breast cancer.

遭受了乳癌的折磨

We often can't think of a young woman

但我們卻很少聯想到某個年輕女性

who has heart disease.

得到心臟疾病

I'm going to tell you why.

讓我來告訴你們為什麼

Heart disease kills people,

心臟疾病是會致命的

often very quickly.

而且通常在很短的時間內

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

所以當人們第一次心臟病發的時候

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

有一半以上的機會立即造成心肌梗塞死亡

no opportunity to say good-bye,

讓人沒有機會說再見

no opportunity to take her to the chemotherapy,

沒有機會帶她去做化療

no opportunity to help her pick out a wig.

也沒有機會幫她挑選假髮

Breast cancer,

乳癌

mortality is down to four percent.

致死率降到只有4%

And that is the 40 years

這是過去40年來

that women have advocated.

女性不斷倡導的結果

Betty Ford, Nancy Reagan stood up

貝蒂芙特，南西雷根都公開站出來

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

說過：「我是乳癌的生還者!」

and it was okay to talk about it.

這不是禁忌的話題

And then physicians have gone to bat.

接著醫師們就開始研究討論

We've done the research.

我們完成了研究

We have effective therapies now.

我們發明了有效的療法

Women are living longer than ever.

於是女性們活得比之前都更久

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

這些事也必須在心臟疾病的領域裡發生，而且該是時候了!

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

是時候了，然而我們卻還未這麼做。

We owe an incredible debt of gratitude

我們該將莫大的感謝

to these two women.

給這兩位女性

As Barbara depicted

芭芭拉

in one of her amazing movies, "Yentl,"

在她一部令人驚豔的電影 「楊朵」 裡面

she portrayed a young woman

詮釋了一位

who wanted an education.

渴望教育的年輕女性

And she wanted to study the Talmud.

她想要學塔木德經

And so how did she get educated then?

所以最後她如何得到教育呢?

She had to impersonate a man.

她必須要扮演成一位男性

She had to look like a man.

必須要看起來就像一位男性

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

她必須要讓別人相信她就像一位男性

and she could have the same rights

並且她可以擁有的權利

that the men had.

跟男性同等

Bernadine Healy, Dr. Healy,

伯纳丁•希利博士

was a cardiologist.

是一位心臟病專家

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

就在那個時候 1980年代

that we saw women and heart disease deaths

當我們看見女性跟心臟病的死亡率

going up, up, up, up, up,

不斷不斷升高的時候

she wrote an editorial

她寫了一篇文章

in the New England Journal of Medicine

發表在新英格蘭醫學雜誌上

and said, the Yentl syndrome.

她說，這就是「楊朵症狀」

Women are dying of heart disease,

女性死於心臟的比例

two, three, four times more than men.

比男性多兩、三、四倍

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

而死亡率並不是在下降而是在上升

And she questioned,

她於是提出疑問

she hypothesized,

她做了假設

is this a Yentl syndrome?

這就是「楊朵症狀」嗎?

And here's what the story is.

故事是這樣的

Is it because women don't look like men,

是不是因為女性不像男性

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

也不像那些我們花了過去五十年

that we've spent the last 50 years understanding

得到良好診斷

and getting really good diagnostics

和完善治療系統

and really good therapeutics,

的男性心臟疾病模式

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

所以女性的心臟疾病沒有被認出來

And they're just passed.

就這樣被忽略了

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

於是她們沒有得到治療，沒有被檢查出來

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

所以現代的藥物也無法對她們帶來一點好處

Doctor Healy then subsequently became

希利醫生接著成為了

the first female director

第一位女性的

of our National Institutes of Health.

美國國家衛生研究院院長

And this is the biggest biomedical enterprise research

這是最具權威的生物醫學研究機構

in the world.

在全世界

And it funds a lot of my research.

它資助了很多我的研究

It funds research all over the place.

它在各地都有資助研究

It was a very big deal

這是一個很重大的決定

for her to become director.

讓她成為院長

And she started,

而她首先

in the face of a lot of controversy,

在一片爭議聲浪中

the Women's Health Initiative.

首先提出了婦女健康關懷研究 (WHI)

And every woman in the room here

所有在座的每一位女性

has benefited from that Women's Health Initiative.

都曾經受惠於這個WHI

It told us about hormone replacement therapy.

它告訴我們荷爾蒙替代療法

It's informed us about osteoporosis.

也告訴了我們骨質疏鬆症

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

它告訴了我們關於發生在女性身上的乳癌、大腸癌

So a tremendous fund of knowledge

這些都需要鉅額的贊助

despite, again,

儘管，

that so many people told her not to do it,

很多人告訴她不要這麼做

it was too expensive.

花費太高了

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

這背後暗喻著大家覺得女性不值得這筆研究花費

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

但她卻說「不，不好意思，女性值得我們這麼做」

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

婦女健康關懷研究(WHI)有一小部份的領域

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

歸屬於國家心臟肺和血液研究所

which is the cardiology part of the NIH.

這個研究所是國家衛生研究院的心血管部門

And we got to do the WISE study --

我們當時要進行WISE研究

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

WISE代表婦女缺血綜合症評估

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

過去十五年我一直領導著這個研究

It was a study to specifically ask,

這研究的主題是

what's going on with women?

女性到底怎麼了?

Why are more and more women dying

為什麼會有越來越多的女性死於

of ischemic heart disease?

缺血性心臟病?

So in the WISE, 15 years ago,

所以十五年前在研究WISE時

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

我們開始想「哇，的確是有幾個關鍵的發現

and we should probably follow up on that."

我們應該繼續追根究柢」

And our colleagues in Washington, D.C.

我們在華盛頓DC的同事

had recently published

當時剛發表了

that when women have heart attacks and die,

當女性遇到心臟病發作而死亡

compared to men who have heart attacks and die --

與男性心臟病發死亡的比較

and again, this is millions of people,

再一次，這事關上百萬的人

happening every day --

而且天天都在發生

women, in their fatty plaque --

女性，在她們的脂肪斑裡

and this is their coronary artery,

這個是她們的冠狀動脈

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

心臟肌肉主要的血液供給從這裡來的

women erode,

女性收縮

men explode.

而男性則是迅速膨脹擴大

You're going to find some interesting analogies

你會發現一些其他有趣的相似之處

in this physiology.

在生理學裡面

(Laughter)

(笑聲)

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

我首先來描述一下男性心臟病發作的型態

Hollywood heart attack. Ughhhh.

好萊屋式的心臟病 厄….

Horrible chest pain.

很嚴重的胸痛

EKG goes pbbrrhh,

心電圖 嗶嗶嗶

so the doctors can see this hugely abnormal EKG.

所以醫生能夠看見極度不正常的心電圖

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

在冠狀動脈的中間有一個很大的凝塊

And they go up to the cath lab

於是他們前往心導管實驗室

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

然後迅速移除凝塊

That's a man heart attack.

這是男性典型的心臟病發作

Some women have those heart attacks,

有些女性也有這種型態的心臟病發作

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

但絕大部分女性的心臟病發作型態都像這樣

where it erodes,

它收縮

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

不完全填滿凝塊，症狀不太容易被發覺

EKG findings are different --

心電圖的偵測也不一樣

female-pattern.

這是女性型態的

So what do you think happens to these gals?

所以你們覺得對於這些女性接下來會發生什麼事情?

They're often not recognized, sent home.

他們經常沒有被發現到，於是就被送回家

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

我也不太確定這是什麼，應該是胃脹氣吧？

So we picked up on that

所以我們選擇繼續研究

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

然後我們想「你知道嗎 ? 我們現在有能力

to look inside human beings

看人體的內部

with these special catheters called IVUS:

透過這些叫做IVUS的特別導管看人體的內部

intravascular ultrasound."

血管內超音波」

And we said, "We're going to hypothesize

然後我們說「我們要來假設

that the fatty plaque in women

女性的脂肪斑

is actually probably different,

跟男性的比起來，

and deposited differently, than men."

其實大有不同、沉澱方法也不同。」

And because of the common knowledge

又因為我們一般

of how women and men get fat.

對於男女性增胖的認知

When we watch people become obese,

當我們看人們變胖的時候

where do men get fat?

男性都在哪裡發胖?

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

就在這，只是局部的，就在那

Where do women get fat?

女性在哪裡發胖?

All over.

到處…

Cellulite here, cellulite here.

這裡是脂肪、這裡也是脂肪

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

所以我們想說「你看，女性看起來

about putting kind of the garbage away,

還蠻會處理廢棄物的

smoothly putting it away.

緩緩地把它們弄開

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

男性就隨手丟在同一個區域」

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

所以我們來看看這個吧!

And so the yellow is the fatty plaque,

黃色的部分是脂肪班

and panel A is a man.

A版塊是男性

And you can see, it's lumpy bumpy.

你可以看見這是塊狀沉著物

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

它在他的冠狀動脈裡面有一個很大的啤酒肚

Panel B is the woman, very smooth.

B版塊是女性，非常平滑

She's just laid it down nice and tidy.

她只是非常溫柔而且整潔的躺下

(Laughter)

(笑聲)

And if you did that angiogram,

而如果你做了這個血管攝影

which is the red,

紅色的

you can see the man's disease.

你就會發現男性的疾病

So 50 years

所以50年來

of honing and crafting these angiograms,

對於這些血管攝影的琢磨

we easily recognize

我們可以輕易的就認出

male-pattern disease.

男性型態的疾病

Kind of hard to see that female-pattern disease.

但是女型疾病的形態卻很難被確立

So that was a discovery.

這是一個重大發現

Now what are the implications of that?

那麼影響會是什麼呢?

Well once again, women get the angiogram

又再一次，女性照了血管攝影

and nobody can tell that they have a problem.

但沒人能夠指出她們是否有問題

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

所以我們現在往非手術式的方向研究

again, these are all invasive studies.

再一次，這些都是手術研究

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

理想上來說你們當然會比較喜歡非手術式的

And again, 50 years

經過50年來

of good non-invasive stress testing,

良好的非手術式壓力研究

we're pretty good at recognizing male-pattern disease

我們已經能夠不錯的透過這個測試

with stress tests.

辨識男性疾病的形態

So this is cardiac magnetic resonance imaging.

這是心臟病患者的核磁共振成像

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

我們在Cedars-Sinai心臟機構的

in the Women's Heart Center.

女性心臟中心做的

We selected this for the research.

我們選擇這張做為研究

This is not in your community hospital,

這不是一般的社區醫院

but we would hope to translate this.

但我們還是希望能夠解讀它

And we're about two and a half years

在五年的研究內

into a five-year study.

我們已經做了兩年半

This was the only modality

這是唯一的方法

that can see the inner lining of the heart.

讓我們可以看到心臟裡層的

And if you look carefully, you can see

如果你看得更仔細一點，會發現

that there's a black blush right there.

那裡有一個黑塊

And that is microvascular obstruction.

那就是微血管堵塞

The syndrome, the female-pattern

這個女性型態的併發症

now is called microvascular coronary dysfunction, or obstruction.

現在稱為，冠狀動脈微血管喪失官能障礙，或堵塞

The second reason we really liked MRI

第二個我們現在很喜歡核磁共振的原因

is that there's no radiation.

是因為它沒有輻射

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

不像電腦斷層掃描、X光、鉈201心肌血流灌注掃瞄檢查

for women

為女性做檢查的時候

whose breast is in the way

胸部會阻礙

of looking at the heart,

檢查心臟的路

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

即便只是少少的輻射量，每次我們想要指示之前都要問問

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

「是不是真正的需要這個檢測?」

So we're very excited about M.R.

所以我們對於核磁共振感到很振奮

You can't go and order it yet,

當然現在還不能說要檢查就可以檢查

but this is an area of active inquiry

但是這是一個現在正在積極探索的領域

where actually studying women

也是一個研究女性

is going to advance the field for women and men.

卻男女同時獲益的領域

What are the downstream consequences

對於接下來的影響會是什麼呢，

then, when female-pattern heart disease

當女性的心臟病

is not recognized?

沒有被辨認出來的時候?

This is a figure

這個數字

from an editorial that I published

是去年夏天我發表在

in the European Heart Journal this last summer.

歐洲心臟期刊裡的文章

And it was just a pictogram

這只是一個圖表

to sort of show

試圖要顯示出

why more women are dying of heart disease,

為什麼女性還是死於心臟疾病?

despite these good treatments

即便在這些很好的治療

that we know and we have work.

以及我們已經做了這麼多之後

And when the woman

而當女性

has male-pattern disease --

擁有男性心臟病型態的狀況下

so she looks like Barbara in the movie --

所以她要長得像是電影裡的Barbara

they get treated.

那她們就會被治癒

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

當妳擁有女性的心臟病型態，而且長得就像個女性

as Barbara does here with her husband,

就像現場跟著她老公一起來的Barbara一樣

they don't get the treatment.

就無法得到治癒

These are our life-saving treatments.

這些是我們的自救療法

And those little red boxes are deaths.

那些紅色的盒子是死亡

So those are the consequences.

就是會帶來的後果

And that is female-pattern

這是女性的型態

and why we think the Yentl syndrome

以及為什麼我們認為「楊朵症狀」

actually is explaining

其實真的能夠解釋

a lot of these gaps.

很多這些差距

There's been wonderful news also

還有一個很棒的消息

about studying women,

關於研究女性

finally, in heart disease.

終於是跟心臟病有關的

And one of the the cutting-edge areas

在這些尖端領域裡

that we're just incredibly excited about

我們非常意外能夠期待的

is stem cell therapy.

是幹細胞治療

If you ask, what is the big difference

如果你問

between women and men physiologically?

在生理學上到底男性跟女性有什麼差別?

Why are there women and men?

為什麼會有男生跟女生之分?

Because women bring new life into the world.

因位女性會為這個世界帶來新生命

That's all stem cells.

而這全都是因為幹細胞的不同

So we hypothesized

所以我們假設

that female stem cells might be better

女性的幹細胞可能在某些部分做得比較好

at identifying the injury,

例如發現傷害

doing some cellular repair

細胞修復

or even producing new organs,

或甚至製造新器官

which is one of the things

這是其中一項

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

我們正在嘗試使用幹細胞療法做出的東西

These are female and male stem cells.

這些是女性及男性的幹細胞

And if you had an injured organ,

如果你有一個受傷的器官

if you had a heart attack

如果你遇到了心臟病發作

and we wanted to repair that injured area,

然後我們想要修復那個受傷的區域

do you want those robust,

你會想要這些健全

plentiful stem cells on the top?

完整的幹細胞如上面這張圖所示?

Or do you want these guys,

還是你會想要這些

that look like they're out to lunch?

好像要外出吃飯的幹細胞?

(Laughter)

(笑聲)

And some of our investigative teams

有一些研究調查團隊

have demonstrated

已經指出

that female stem cells --

女性的幹細胞

and this is in animals

（適用在動物界裡面

and increasingly we're showing this in humans --

和慢慢衍伸到人類世界）

that female stem cells,

若將女性的幹細胞

when put even into a male body,

放進男性的身體裡

do better than male stem cells

表現得還比

going into a male body.

男性本身的幹細胞還優秀

One of the things that we say

其中一項原因讓我們

about all of this female physiology --

討論女性生理學

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

是因為儘管我們討論心臟疾病跟女性朋友們的關係

women do, on average,

平均來說

have better longevity than men --

女性擁有比男性更長的壽命

is that unfolding the secrets of female physiology

就是要揭開這些女性生理學未知的部分

and understanding that

並且了解

is going to help men and women.

這麼做對不管男生或是女生同時都有益處

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

這絕對不是所謂的零和博弈

Okay, so here's where we started.

OK 所以我們回到我們開始的地方吧!

And remember, paths crossed in 1984,

記住，兩條線在1984年交會

and more and more women

接著越來越多的女性

were dying of cardiovascular disease.

因為心血管疾病死亡

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

過去十五年我們作了些什麼?

We are bending the curve.

我們讓曲線轉向了

We're bending the curve.

我們讓曲線轉向了

So just like the breast cancer story,

就像乳癌的故事一樣

doing research, getting awareness going,

做研究，讓大家意識到這件事

it works, you just have to get it going.

這些事情是有成效的，只是還需要更加努力

Now are we happy with this?

但我們現在就滿意了嗎?

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

現在女性的死亡率還是男性的二到三倍

And I would propose,

我會建議

with the better longevity

較長壽命的優勢

that women have overall,

是女性擁有的

that women probably should theoretically do better,

理論上女性可以再活得更久

if we could just get treated.

只要我們能夠被妥善治療

So this is where we are,

我們現在在這裡

but we have a long row to hoe.

但我們還有很長一段路要努力

We've worked on this for 15 years.

我們已經在這方面研究15年了

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

但如同我跟你們說過的，我們已經在男性的心臟病型態上

for 50 years.

已經研究了50年

So we're 35 years behind.

所以我們還落後了35年

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

當然我們不希望要花我們35年的時間去追上

And in fact, it probably won't.

事實上應該也不需要

But we cannot stop now.

但我們不能因而現在就停止

Too many lives are at stake.

有太多的生命在危急關頭

So what do we need to do?

所以我們必須做些什麼呢?

You now, hopefully, have a more personal relationship

希望你們現在

with your heart.

跟你們的心臟關係更好了

Women have heard the call

女性都曾經聽過

for breast cancer

對乳癌的呼籲

and they have come out

也站出來參與

for awareness campaigns.

認識乳癌的活動

The women are very good about getting mammograms now.

女性對於照乳房X光片也很坦然

And women do fundraising.

女性們還會籌款

Women participate.

她們融入參與其中

They have put their money where their mouth is

他們把錢投入在他們提倡的事物當中

and they have done advocacy and they have joined campaigns.

而他們參與活動提倡對乳癌的認知

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

這正是我們對於心臟疾病應該要做的事情

And it's political.

而且它是政治化的

Women's health, from a federal funding standpoint,

女性的健康，從國家資金的觀點來看

sometimes it's popular,

有時候是受歡迎的

sometimes it's not so popular.

有時候卻不然

So we have these feast and famine cycles.

所以會有時好時壞的循環

So I implore you

因此我在這裡懇請大家

to join the Red Dress Campaign

參加紅衣活動

in this fundraising.

參與募款

Breast cancer, as we said,

如同我們說的，乳癌

kills women,

會讓女性致命

but heart disease kills a whole bunch more.

但心臟疾病其實讓更多的女性因此送命

So if we can be as good as breast cancer

如果我們做得跟乳癌一樣好

and give women this new charge,

賦予女性這個責任

we have a lot of lives to save.

我們就能夠因此挽救很多條生命

So thank you for your attention.

謝謝大家的參與

(Applause)

(掌聲)