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