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.
在座的女性,有二分之一的妳們 在妳們的一生當中 將會遭受到心臟血管疾病 所以我們可以說它是女性的頭號殺手 但這卻是一個沒有被公開秘密 我也不知道為什麼 除了讓這個訊息涉及到每一個人身上以外 我們當然會先討論妳和妳心臟之間的關係 還有所有女性與她們心臟之間的關係 接著,我們還要把它擴及到政治上面 畢竟,涉及個人私事的事情,通常也都是政治化的 至今人們對此做的還不夠 但因為我們都曾經看過 看過女性在乳癌相關活動中 戰勝乳癌的例子 這就是現階段我們必須要對心臟做的事情
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.
自從1984年以來 在美國女性因為心臟疾病死亡的人數大於男性 過去我們一直認為 「心血管疾病主要是男性的疾病」 其實一直都不是真的 但在1950、60的年代,幾乎所有人都這麼覺得 連教科書上也都這麼說 可以肯定的是在我就學階段我是這樣被教育的 如果我們是想要維持性別主義的話,那這個論點是錯的 但如果我們想要有所進步並且同時維持性別主義的話 心血管疾病其實是女性的疾病 所以,這現在是女性的疾病了
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.
你們可以發現一件事 在男性的趨勢線上面 死亡率一直不斷的下降,下降,下降 接著再看到1984年以來的女性死亡率 與男性的差距不斷擴大 越來越多的女性,以兩倍到三倍到四倍 的差距遠勝於男性因心臟疾病的死亡率 而在那麼短的時間內 據我們所知,就算所有的危險因子加在一起 也不足以做出改變 所以,這個圖表真正帶給我們的啟發是 以整體而言 在過去五十年來 所有國內的診斷和治療策略 都是在男性身上,並且針對男性而發明的 而且也都還滿有效的,對吧? 但對於女性來說就沒這麼有效了 所以,在80年代的時候 這個數據喚起了大家的重視
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.
那就是,心臟疾病對各個女性朋友們的年齡層來說 都比乳癌 來得致命 關於乳癌防治推廣運動 當然,這不是競賽 我們試著要做得跟乳癌防治運動一樣好 我們必須要做得跟乳癌防治運動一樣好 才可以對付這個危機 有時候當人們看見這個圖表的時候 我會聽見倒吸氣的聲音 我們常常都可以聯想到某個人 經常是一位年輕女性 遭受了乳癌的折磨 但我們卻很少聯想到某個年輕女性 得到心臟疾病 讓我來告訴你們為什麼 心臟疾病是會致命的 而且通常在很短的時間內 所以當人們第一次心臟病發的時候 有一半以上的機會立即造成心肌梗塞死亡 讓人沒有機會說再見 沒有機會帶她去做化療 也沒有機會幫她挑選假髮
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.
乳癌 致死率降到只有4% 這是過去40年來 女性不斷倡導的結果 貝蒂芙特,南西雷根都公開站出來 說過:「我是乳癌的生還者!」 這不是禁忌的話題 接著醫師們就開始研究討論 我們完成了研究 我們發明了有效的療法 於是女性們活得比之前都更久 這些事也必須在心臟疾病的領域裡發生,而且該是時候了! 是時候了,然而我們卻還未這麼做。
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?
我們該將莫大的感謝 給這兩位女性 芭芭拉 在她一部令人驚豔的電影 「楊朵」 裡面 詮釋了一位 渴望教育的年輕女性 她想要學塔木德經 所以最後她如何得到教育呢? 她必須要扮演成一位男性 必須要看起來就像一位男性 她必須要讓別人相信她就像一位男性 並且她可以擁有的權利 跟男性同等 伯纳丁•希利博士 是一位心臟病專家 就在那個時候 1980年代 當我們看見女性跟心臟病的死亡率 不斷不斷升高的時候 她寫了一篇文章 發表在新英格蘭醫學雜誌上 她說,這就是「楊朵症狀」 女性死於心臟的比例 比男性多兩、三、四倍 而死亡率並不是在下降而是在上升 她於是提出疑問 她做了假設 這就是「楊朵症狀」嗎?
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.
故事是這樣的 是不是因為女性不像男性 也不像那些我們花了過去五十年 得到良好診斷 和完善治療系統 的男性心臟疾病模式 所以女性的心臟疾病沒有被認出來 就這樣被忽略了 於是她們沒有得到治療,沒有被檢查出來 所以現代的藥物也無法對她們帶來一點好處
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."
希利醫生接著成為了 第一位女性的 美國國家衛生研究院院長 這是最具權威的生物醫學研究機構 在全世界 它資助了很多我的研究 它在各地都有資助研究 這是一個很重大的決定 讓她成為院長 而她首先 在一片爭議聲浪中 首先提出了婦女健康關懷研究 (WHI) 所有在座的每一位女性 都曾經受惠於這個WHI 它告訴我們荷爾蒙替代療法 也告訴了我們骨質疏鬆症 它告訴了我們關於發生在女性身上的乳癌、大腸癌 這些都需要鉅額的贊助 儘管, 很多人告訴她不要這麼做 花費太高了 這背後暗喻著大家覺得女性不值得這筆研究花費 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 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.
婦女健康關懷研究(WHI)有一小部份的領域 歸屬於國家心臟肺和血液研究所 這個研究所是國家衛生研究院的心血管部門 我們當時要進行WISE研究 WISE代表婦女缺血綜合症評估 過去十五年我一直領導著這個研究 這研究的主題是 女性到底怎麼了? 為什麼會有越來越多的女性死於 缺血性心臟病? 所以十五年前在研究WISE時 我們開始想「哇,的確是有幾個關鍵的發現 我們應該繼續追根究柢」 我們在華盛頓DC的同事 當時剛發表了 當女性遇到心臟病發作而死亡 與男性心臟病發死亡的比較 再一次,這事關上百萬的人 而且天天都在發生 女性,在她們的脂肪斑裡 這個是她們的冠狀動脈 心臟肌肉主要的血液供給從這裡來的 女性收縮 而男性則是迅速膨脹擴大 你會發現一些其他有趣的相似之處 在生理學裡面
(Laughter)
(笑聲)
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.
我首先來描述一下男性心臟病發作的型態 好萊屋式的心臟病 厄…. 很嚴重的胸痛 心電圖 嗶嗶嗶 所以醫生能夠看見極度不正常的心電圖 在冠狀動脈的中間有一個很大的凝塊 於是他們前往心導管實驗室 然後迅速移除凝塊 這是男性典型的心臟病發作 有些女性也有這種型態的心臟病發作 但絕大部分女性的心臟病發作型態都像這樣 它收縮 不完全填滿凝塊,症狀不太容易被發覺 心電圖的偵測也不一樣 這是女性型態的 所以你們覺得對於這些女性接下來會發生什麼事情? 他們經常沒有被發現到,於是就被送回家 我也不太確定這是什麼,應該是胃脹氣吧?
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."
所以我們選擇繼續研究 然後我們想「你知道嗎 ? 我們現在有能力 看人體的內部 透過這些叫做IVUS的特別導管看人體的內部 血管內超音波」 然後我們說「我們要來假設 女性的脂肪斑 跟男性的比起來, 其實大有不同、沉澱方法也不同。」 又因為我們一般 對於男女性增胖的認知 當我們看人們變胖的時候 男性都在哪裡發胖? 就在這,只是局部的,就在那 女性在哪裡發胖? 到處… 這裡是脂肪、這裡也是脂肪 所以我們想說「你看,女性看起來 還蠻會處理廢棄物的 緩緩地把它們弄開 男性就隨手丟在同一個區域」 所以我們來看看這個吧!
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.
黃色的部分是脂肪班 A版塊是男性 你可以看見這是塊狀沉著物 它在他的冠狀動脈裡面有一個很大的啤酒肚 B版塊是女性,非常平滑 她只是非常溫柔而且整潔的躺下 (笑聲) 而如果你做了這個血管攝影 紅色的 你就會發現男性的疾病 所以50年來 對於這些血管攝影的琢磨 我們可以輕易的就認出 男性型態的疾病 但是女型疾病的形態卻很難被確立 這是一個重大發現 那麼影響會是什麼呢? 又再一次,女性照了血管攝影 但沒人能夠指出她們是否有問題
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.
所以我們現在往非手術式的方向研究 再一次,這些都是手術研究 理想上來說你們當然會比較喜歡非手術式的 經過50年來 良好的非手術式壓力研究 我們已經能夠不錯的透過這個測試 辨識男性疾病的形態 這是心臟病患者的核磁共振成像 我們在Cedars-Sinai心臟機構的 女性心臟中心做的 我們選擇這張做為研究 這不是一般的社區醫院 但我們還是希望能夠解讀它 在五年的研究內 我們已經做了兩年半
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.
這是唯一的方法 讓我們可以看到心臟裡層的 如果你看得更仔細一點,會發現 那裡有一個黑塊 那就是微血管堵塞 這個女性型態的併發症 現在稱為,冠狀動脈微血管喪失官能障礙,或堵塞 第二個我們現在很喜歡核磁共振的原因 是因為它沒有輻射 不像電腦斷層掃描、X光、鉈201心肌血流灌注掃瞄檢查 為女性做檢查的時候 胸部會阻礙 檢查心臟的路 即便只是少少的輻射量,每次我們想要指示之前都要問問 「是不是真正的需要這個檢測?」 所以我們對於核磁共振感到很振奮 當然現在還不能說要檢查就可以檢查 但是這是一個現在正在積極探索的領域 也是一個研究女性 卻男女同時獲益的領域
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.
對於接下來的影響會是什麼呢, 當女性的心臟病 沒有被辨認出來的時候? 這個數字 是去年夏天我發表在 歐洲心臟期刊裡的文章 這只是一個圖表 試圖要顯示出 為什麼女性還是死於心臟疾病? 即便在這些很好的治療 以及我們已經做了這麼多之後 而當女性 擁有男性心臟病型態的狀況下 所以她要長得像是電影裡的Barbara 那她們就會被治癒 當妳擁有女性的心臟病型態,而且長得就像個女性 就像現場跟著她老公一起來的Barbara一樣 就無法得到治癒 這些是我們的自救療法 那些紅色的盒子是死亡 就是會帶來的後果 這是女性的型態 以及為什麼我們認為「楊朵症狀」 其實真的能夠解釋 很多這些差距
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?
還有一個很棒的消息 關於研究女性 終於是跟心臟病有關的 在這些尖端領域裡 我們非常意外能夠期待的 是幹細胞治療 如果你問 在生理學上到底男性跟女性有什麼差別? 為什麼會有男生跟女生之分? 因位女性會為這個世界帶來新生命 而這全都是因為幹細胞的不同 所以我們假設 女性的幹細胞可能在某些部分做得比較好 例如發現傷害 細胞修復 或甚至製造新器官 這是其中一項 我們正在嘗試使用幹細胞療法做出的東西 這些是女性及男性的幹細胞 如果你有一個受傷的器官 如果你遇到了心臟病發作 然後我們想要修復那個受傷的區域 你會想要這些健全 完整的幹細胞如上面這張圖所示? 還是你會想要這些 好像要外出吃飯的幹細胞?
(Laughter)
(笑聲)
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.
有一些研究調查團隊 已經指出 女性的幹細胞 (適用在動物界裡面 和慢慢衍伸到人類世界) 若將女性的幹細胞 放進男性的身體裡 表現得還比 男性本身的幹細胞還優秀 其中一項原因讓我們 討論女性生理學 是因為儘管我們討論心臟疾病跟女性朋友們的關係 平均來說 女性擁有比男性更長的壽命 就是要揭開這些女性生理學未知的部分 並且了解 這麼做對不管男生或是女生同時都有益處 這絕對不是所謂的零和博弈
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.
OK 所以我們回到我們開始的地方吧! 記住,兩條線在1984年交會 接著越來越多的女性 因為心血管疾病死亡 過去十五年我們作了些什麼? 我們讓曲線轉向了 我們讓曲線轉向了 就像乳癌的故事一樣 做研究,讓大家意識到這件事 這些事情是有成效的,只是還需要更加努力 但我們現在就滿意了嗎? 現在女性的死亡率還是男性的二到三倍
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.
我會建議 較長壽命的優勢 是女性擁有的 理論上女性可以再活得更久 只要我們能夠被妥善治療 我們現在在這裡 但我們還有很長一段路要努力 我們已經在這方面研究15年了 但如同我跟你們說過的,我們已經在男性的心臟病型態上 已經研究了50年 所以我們還落後了35年 當然我們不希望要花我們35年的時間去追上 事實上應該也不需要 但我們不能因而現在就停止 有太多的生命在危急關頭
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.
所以我們必須做些什麼呢? 希望你們現在 跟你們的心臟關係更好了 女性都曾經聽過 對乳癌的呼籲 也站出來參與 認識乳癌的活動 女性對於照乳房X光片也很坦然 女性們還會籌款 她們融入參與其中 他們把錢投入在他們提倡的事物當中 而他們參與活動提倡對乳癌的認知 這正是我們對於心臟疾病應該要做的事情
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.
而且它是政治化的 女性的健康,從國家資金的觀點來看 有時候是受歡迎的 有時候卻不然 所以會有時好時壞的循環 因此我在這裡懇請大家 參加紅衣活動 參與募款 如同我們說的,乳癌 會讓女性致命 但心臟疾病其實讓更多的女性因此送命 如果我們做得跟乳癌一樣好 賦予女性這個責任 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)