The single biggest health threat women face Noel Bairey Merz

one a tattoo 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 relationships 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 since 1984 more women

die in the US 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 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 goink 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 for 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 1980s heart disease kills

more women at all ages than breast

cancer and the breast cancer can

pain 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 goodbye no

opportunity to take her to the

chemotherapy no opportunity to help her

pick out a wig 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 the 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 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 man had Bernadine Healy

dr. Healy it’s a cardiologist and right

around that time in the 1980s 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 young ttle syndrome women are

dying of heart disease two three four

times more than men mortality is not

down it’s going up and she questions she

hypothesized is this a Yentl syndrome

and here’s what the story is 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 just passed they don’t get treated

they don’t get detected they don’t get

the benefit of all the modern medicines

dr. 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 it’s about osteoporosis and

informed us about breast cancer colon

cancer and women so a tremendous fund of

knowledge despite again that so many

people told her not to do it was too

expensive and and the you know the

underwriting was women aren’t worth it

she was like no sorry women are worth it

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 ischaemia

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 ischaemic heart disease

so in the wise 15 years ago we started

out and said well wow you know there’s a

couple of key observations and we should

probably follow up on that and our

colleagues in Washington DC had recently

published that when women have heart

attacks and die compared to men who have

heart attacks and die and again this is

you know millions of people happening

all every day

a women in their fatty plaque and this

is their coronary arteries 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 so I’ll describe the male

pattern heart attack first you know

Hollywood heart attack oh you know

horrible chest pain EKG goes Paul 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 you know 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 two roads doesn’t

completely fill with clot symptoms are

subtle EKG findings are different female

pattern so what do you think happens to

these look ELLs they’re often not

recognized sent home I’m not sure what

it was might have been gas so we picked

up on that and we said we know we now

have the ability to look inside human

beings with these special catheters

called ivis 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

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

celluloid 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 man just have

to dump it in a single area so we said

let’s look at these 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 and if 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

recognized male pattern disease kind of

hard to see that female pattern disease

so that was a discovery now what are the

implications of that once again women

get the angiogram and nobody can tell

that they have a problem so we are

working now on 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 Cedar sinai Heart Institute and the

woman’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 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

micro vascular obstruction the 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 thallium for women who

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 mr you can’t go and

order it yet but this is an air

area of active inquiry we’re actually

studying women is going to advance the

field for women and men 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 that is the consequences

and that is female pattern and why we

think the Yentl syndrome actually is is

explaining a lot of these gaps there’s

been wonderful news also about studying

women finally in heart disease and one

of the cutting-edge areas that were just

incredibly excited about is stem cell

therapy if you ask what is the big

difference between women and men

physiologically why 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 the 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

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 the unfolding

the secrets of female physiology and

understanding that is going to help men

and and women so this is not a zero-sum

game in any way 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 curb 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 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 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 that 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

advocacy and they have joined campaigns

this is what we need to do with heart

disease now 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 so

thank you for your attention

you