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.
二分之一的女性 一生中会受到心血管疾病 的影响。 这是女性的头号杀手。 我不知道为什么 不为人所知。 除了针对个人以外-- 我们要谈论你与你心脏的关系, 所有女性与心脏的关系-- 我们要铸进政治中去。 因为个人呢,也是政治化的。 在这一点上做得还不够。 我们都曾经见过 借助乳腺癌的宣传 女性在征服乳腺癌。 现在我们也应当这样来对待我们的心脏。
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.
从1984年以来 在美国,女性的死亡率高于男性。 我们那时都习惯认为 心脏病是男性的主要问题- 其实从来就不正确。 但20世纪五,六十年代人人都这样认为, 并且课本里都是这样的。 我受训的时候就是这样学的。 五六十年代那种含有性别歧视色彩的观点是不对的。 可是,为了讨论这个问题,就让我们站在女性立场上吧。 心脏疾病实际就是女性的疾病。 现在是女性的疾病。
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.
有一件事情你看到的是, 这条男性线上的 死亡率一直在下降,下降,下降。 从1984年来,女性这条线, 差距在加宽。 越来越多的女性,死于心脏疾病的 比男性多两倍,三倍或四倍。 在这个太短的时间内, 我们有诸多的不同威胁因素 要改变。 所以,这就建议我们 采取国家级别的 诊断和治疗策略, 因为在过去的50年里曾被男性开发, 也为男性服务, 它们也起了很好的作用,是不是? 但,女性们没得到什么好处。 那是80年代的 一个大警钟。
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.
无论哪个年龄段, 女性的心脏病死亡率 都高于乳腺癌。 虽然乳腺癌作了宣传活动, 但这不是竞争。 我们要做像乳腺癌同样好的宣传活动。 我们需要做和乳腺癌同样好的活动 来解决这场危机。 有时,人们看到这些 就会叹气. 我们可以想到某个人, 常常是一位很年轻的妇女 会受乳腺癌的影响。 我们却不会想到一位年轻的妇女 会得心脏病。 我要告诉大家为什么这样。 心脏病发作死亡, 经常很快。 所以心脏病第一次袭击男性和女性, 半数是心源性猝死-- 没机会说再见, 没机会带她去做化疗, 没机会帮她挑选假发。
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.
乳腺癌 死亡率下降了4个百分点。 这就是40年来 妇女呼吁的结果。 贝蒂•福特,南希.里根曾经站起来 说:“我是乳腺癌的幸存者,” 这是可以谈论的。 于是,医师们就去着手。 我们做了调查。 我们现在拥有有效的疗法。 女性比以前更长寿。 对待心脏病也应该这样,是时候了。 现在还没做什么,是时候了。
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?
我们对这两位女性 欠下感激之债。 就像芭芭拉 在她的一部很棒的电影《燕特尔》“Yentl”里 刻画了一位年轻的女性 想要受教育。 她想学习犹太法典。 那她怎么样接受的教育呢? 她必需得装扮成男人。 她必需看上去像个男人。 她必需让别人相信她像个男人, 她有男人该有的 同样的权利。 伯纳丁·希利, 希利医师是个心脏病学家。 当时是1980年代, 我们看到女性心脏病死亡 一直上升,上升,上升, 她在新英格兰医学杂志上 写了一篇社论, 说到燕特尔综合症。 死于心脏病的女性 是男性的两倍,三倍或四倍。 死亡率没有下降,而在上升。 她质疑过, 她假设过 这是一种燕特尔综合症吗?
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.
故事是这样的。 因为女性长的不像男性, 她们的心脏病不像男性模式, 她们没有我们研究了50年而理解的 真正好的诊断 和真正好的治疗。 因此,她们的心脏病没被公认。 她们就这样走了。 她们没得到医治,她们没被检测, 她们没有得益于所有的现代医药。
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."
希利医师后来成为 美国国家卫生部的 首位女部长。 这是世界上最大的 生物医学企业研究。 我的许多研究是由它赞助的。 它赞助的研究到处都有。 她当部长 是很轰动一时的。 她开始的时候, 面临了许多 对女性健康倡议的争议。 在座的每一位女性 都得益于妇女健康倡议。 它告诉我们激素替代疗法。 它告诉我们骨质疏松症。 它告诉我们女性的乳腺癌,大肠癌。 尽管有巨大的知识积累 但还是 有许多人告诉她不要去做, 因为它太昂贵了。 字里行间是说女性不值得。 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 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.
于是有一小部分的妇女健康倡议, 进入到国家心脏,肺和血液研究所 就是国家卫生研究院的心脏学部分。 我们去做的WISE研究-- WISE代表妇女缺血综合症评估-- 我已经主持这项研究达15年之久。 这个研究在明确地问, 妇女到底怎么了? 为什么越来越多的女性死于 缺铁性心脏病。 15年前,在妇女缺血综合症评估里, 我们开始说,:“好哇,有几个关键的意见, 我们也许应该跟进观察。” 在华盛顿特区, 我们的同行们最近发表文章, 把女性和男性 因心脏病致死做了比较-- 仍有成千上万的人 每天还在发生-- 女性在她们的脂肪斑块里 这是冠状动脉, 主要的血液供应进到心脏肌肉时, 女性是受侵蚀式, 男性是爆炸式。 你们会在生理学上找到些 有趣的相似。
(Laughter)
(笑)
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. That's a man heart attack. Some women have those heart attacks, but a whole bunch of women have this kind of heart attack, where it erodes, doesn't completely fill with clot, symptoms are subtle, EKG findings are different -- female-pattern. So what do you think happens to these gals? They're often not recognized, sent home. I'm not sure what it was. Might have been gas.
我先来描述一下男性模式的心脏病发作。 好莱坞式的心脏病发作。啊。。。 可怕的胸口痛。 心电图一下子跳上去, 所以医生看到的是巨大的异常心电图。 动脉当中有一个大的血块。 他们去到心导管室, 嘭嘭嘭就把血块拿掉。 那是男性的心脏病发作。 有些女性也是这样, 但很多的妇女的心脏病发作是, 动脉受到侵蚀 但没有完全被血块阻塞,症状不明显, 心电图也不一样-- 这就是女性模式。 这些女性会怎么样呢? 经常是,她们没被识别为心脏病发作,而被送回家。 我不清楚是什么。可能是内部有气体。
So we picked up on that and we said, "You know, we now have the ability to look inside human beings with these special catheters called IVUS: intravascular ultrasound." And we said, "We're going to hypothesize that the fatty plaque in women is actually probably different, and deposited differently, than men." And because of the common knowledge of how women and men get fat. When we watch people become obese, where do men get fat? Right here, it's just a focal -- right there. Where do women get fat? All over. Cellulite here, cellulite here. So we said, "Look, women look like they're pretty good about putting kind of the garbage away, smoothly putting it away. Men just have to dump it in a single area." So we said, "Let's look at these."
所以我们会注意到, 说,“我们现在有能力 用这些特殊的叫做IVUS的管道 来透视人体内部: 血管内超声检查。” 我们说,“我们要假设 女性体内的脂肪斑块 与男性的不同, 并且存积方式也不同。” 根据男女 如何变胖的常识。 当我们看到人发福, 男性胖在哪儿呢? 就在这,就一个焦点--这里。 女性胖到哪儿呢? 全身都是。 这里一块赘肉,这里一团脂肪。 因此我们说:“看哪,女人们很会 把这些垃圾分散好, 分得很顺利。 男人只能倒进一个地方。” 我们说,“来看看这些。”
And so the yellow is the fatty plaque, and panel A is a man. And you can see, it's lumpy bumpy. He's got a beer belly in his coronary arteries. Panel B is the woman, very smooth. She's just laid it down nice and tidy. (Laughter) And if you did that angiogram, which is the red, you can see the man's disease. So 50 years of honing and crafting these angiograms, we easily recognize male-pattern disease. Kind of hard to see that female-pattern disease. So that was a discovery. Now what are the implications of that? Well once again, women get the angiogram and nobody can tell that they have a problem.
黄色是脂肪斑块, A组是男人。 你能看到,是波浪不平的。 在他的冠状动脉里长了个啤酒肚。 B组是女性,非常平滑。 她把它摆得整洁漂亮。 (笑) 如果你做过血管造影, 就是这个红色, 你可以看到男性的疾病。 经过50年的 磨练和制作这些血管造影, 我们很容易认出 男性模式的疾病。 但难于看到女性模式的疾病。 所以,才有了个发现。 言外之意是什么呢? 就是,女性也做血管造影片, 但没有人能告诉她们有问题。
So we are working now on a non-invasive -- again, these are all invasive studies. Ideally you would love to do all this non-invasively. And again, 50 years of good non-invasive stress testing, we're pretty good at recognizing male-pattern disease with stress tests. So this is cardiac magnetic resonance imaging. We're doing this at the Cedars-Sinai Heart Institute in the Women's Heart Center. We selected this for the research. This is not in your community hospital, but we would hope to translate this. And we're about two and a half years into a five-year study.
我们在着手于一个非侵略性的研究,-- 事实上,这些研究都是侵略性的。 最理想的是,你会想用非侵入法来做这些研究。 再重复一遍,五十年的 很好的非侵入的压力测试, 我们很在行从这些测试中认出 男性模式的疾病。 这就是心脏磁共振成像。 我们在妇女心脏中心的雪松西奈山心脏中心 做这些研究。 我们为这项研究做了选择。 这虽然不是你的社区医院, 我们希望能传递相同的信息。 我们为期5年的研究 已进行了一半。
This was the only modality that can see the inner lining of the heart. And if you look carefully, you can see that there's a black blush right there. And that is microvascular obstruction. The syndrome, the female-pattern now is called microvascular coronary dysfunction, or obstruction. The second reason we really liked MRI is that there's no radiation. So unlike the CAT scans, X-rays, thalliums, for women whose breast is in the way of looking at the heart, every time we order something that has even a small amount of radiation, we say, "Do we really need that test?" So we're very excited about M.R. You can't go and order it yet, but this is an area of active inquiry where actually studying women is going to advance the field for women and men.
这是能看到心脏内膜的 唯一模式。 如果你仔细看, 会看到这里有个黑黑的血块。 那就是微血管阻塞。 这种女性模式的症状 就叫做冠状动脉微血管功能障碍或阻塞。 我们喜欢核磁共振成像的第二个原因 是它没有辐射。 不像计算机辅助测试扫描,X光片,铊扫描等 因为女性 每次做心脏测试 都会考虑对乳房的影响, 哪怕小数量的辐射, 我们也会说:“真有做这个测试的必要吗?” 我们对核磁共振非常兴奋。 你们还不能现在就去使用它, 但这是个积极探究的领域, 对女性的研究 将推进男性和女性的领域。
What are the downstream consequences then, when female-pattern heart disease is not recognized? This is a figure from an editorial that I published in the European Heart Journal this last summer. And it was just a pictogram to sort of show why more women are dying of heart disease, despite these good treatments that we know and we have work. And when the woman has male-pattern disease -- so she looks like Barbara in the movie -- they get treated. And when you have female-pattern and you look like a woman, as Barbara does here with her husband, they don't get the treatment. These are our life-saving treatments. And those little red boxes are deaths. So those are the consequences. And that is female-pattern and why we think the Yentl syndrome actually is explaining a lot of these gaps.
女性模式心脏病的 未被识别的后果 是如何呢? 这个数据 是从我去年发表在 欧洲心脏杂志上的一片社论来的。 这个象形图 显示, 尽管我们知道 很多的有效的治疗法, 为什么还有更多的女性死于心脏病。 当女性出现 男性模式的病症-- 就像电影里的芭芭拉一样, 她们才会得到医治。 当你有女性模式的症状,但你看上去也是女性 就像芭芭拉和她丈夫, 他们就得不到医治。 这些都是挽救生命的疗法。 这些小红框子是死亡的。 这些是后果。 那个是女性模式, 并且我们认为燕特尔综合症 也确实解释了 这些差距。
There's been wonderful news also about studying women, finally, in heart disease. And one of the the cutting-edge areas that we're just incredibly excited about is stem cell therapy. If you ask, what is the big difference between women and men physiologically? Why are there women and men? Because women bring new life into the world. That's all stem cells. So we hypothesized that female stem cells might be better at identifying the injury, doing some cellular repair or even producing new organs, which is one of the things that we're trying to do with stem cell therapy. These are female and male stem cells. And if you had an injured organ, if you had a heart attack and we wanted to repair that injured area, do you want those robust, plentiful stem cells on the top? Or do you want these guys, that look like they're out to lunch?
对于研究女性方面 有很多好消息, 最后终于轮到心脏病了。 还有一个 让我们异常兴奋的前沿领域 是干细胞疗法。 如果你问,在生理上 女性与男性的大的不同之处在哪? 为什么会有女性和男性? 因为女性把新生命带到世上。 这全是干细胞。 我们假定 女性干细胞会很好地 鉴别损伤, 做些细胞修补 或产生新的器官, 这就是我们正在尝试 用干细胞疗法做到的。 这就是女性和男性干细胞。 如果你的器官受损, 或你心脏病发作, 我们想修复受伤的地方, 你想不想最先用 这些强健又足够的干细胞? 或者,你想他们 这样无精打采呢?
(Laughter)
(笑)
And some of our investigative teams have demonstrated that female stem cells -- and this is in animals and increasingly we're showing this in humans -- that female stem cells, when put even into a male body, do better than male stem cells going into a male body. One of the things that we say about all of this female physiology -- because again, as much as we're talking about women and heart disease, women do, on average, have better longevity than men -- is that unfolding the secrets of female physiology and understanding that is going to help men and women. So this is not a zero-sum game in anyway.
我们的一些调查团队 曾展示 女性干细胞-- 这是动物的 并且在人类也有增长- 就是当我们把女性干细胞 注入男性体内, 它们比男性干细胞 工作得更好。 我们讲的 女性生理之一 因为我们在谈论女性与心脏病, 通常女性 比男性长寿。 揭示和认识女性的 生理秘密 将会帮助男性和女性。 这不是零合的游戏。
Okay, so here's where we started. And remember, paths crossed in 1984, and more and more women were dying of cardiovascular disease. What has happened in the last 15 years with this work? We are bending the curve. We're bending the curve. So just like the breast cancer story, doing research, getting awareness going, it works, you just have to get it going. Now are we happy with this? We still have two to three more women dying for every man.
好,我们从这里开始。 请记住,交叉点是在1984年, 越来越多的女性 死于心脏病。 在过去的15年里都做了些什么? 这个曲线在打弯。 我们在折弯这条曲线。 就像乳腺癌的故事, 做些调查,让更多人认识到, 它管用的,我们必须继续做下去。 现在我们满意吗? 女性的死亡率仍是男性的两到三倍。
And I would propose, with the better longevity that women have overall, that women probably should theoretically do better, if we could just get treated. So this is where we are, but we have a long row to hoe. We've worked on this for 15 years. And I've told you, we've been working on male-pattern heart disease for 50 years. So we're 35 years behind. And we'd like to think it's not going to take 35 years. And in fact, it probably won't. But we cannot stop now. Too many lives are at stake.
那我提议, 总的来说 女性比较长寿, 如果我们女性得到医治, 理论上我们的情况会更好。 所以这是我们现在的状况, 更艰巨的在后头。 我们已经工作了15年。 我也说过,我们在男性心脏病上 已花了50年的时间。 我们落后了35年。 我们愿意相信,不用再花35年的时间。 事实上也许不会。 现在不能停步。 太多生命处于危险。
So what do we need to do? You now, hopefully, have a more personal relationship with your heart. Women have heard the call for breast cancer and they have come out for awareness campaigns. The women are very good about getting mammograms now. And women do fundraising. Women participate. They have put their money where their mouth is and they have done advocacy and they have joined campaigns. This is what we need to do with heart disease now.
我们需要做什么? 希望大家跟你的心脏有个 更好的个人关系。 女性听到了 乳腺癌的呼声, 大家就出来 做宣传活动。 女性都知道做乳房X线照片。 女性做筹款活动。 女性积极参与。 她们省吃俭用 她们参加宣传,她们参加各种活动。 我们对于心脏病也要这样做。
And it's political. Women's health, from a federal funding standpoint, sometimes it's popular, sometimes it's not so popular. So we have these feast and famine cycles. So I implore you to join the Red Dress Campaign in this fundraising. Breast cancer, as we said, kills women, but heart disease kills a whole bunch more. So if we can be as good as breast cancer and give women this new charge, we have a lot of lives to save.
这是政治。 从联邦资金的角度看, 女性健康有时是受重视, 有时不受重视。 这就我们有盛宴和饥荒的循环。 我恳求大家 去参加红衣活动 的筹款。 我们说乳腺癌 害死妇女, 但心脏病害死更多。 所以,如果我们能做得像乳腺癌那样好, 给女性新的任务, 我们会拯救很多生命。
So thank you for your attention.
谢谢您的关注。
(Applause)
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