Transcriber: Helena Galani Reviewer: Denise RQ
I'm here to talk about the facts.
The facts.
Heart disease kills more women than all cancers combined.
4% of women are diagnosed with breast cancer annually
whereas 44% of women are diagnosed with heart disease.
Even though heart disease has been called a man's disease,
since 1984, more women have died annually from heart disease than men.
In the US, 39,520 women died of breast cancer last year
but nearly 500,000 women died from heart disease.
Put another way, in worldwide figures
about 400,000 women died from breast cancer
but 8,6 million women died from heart disease.
Given these statistics only 24% of participants
in all heart-related studies are women.
For 50 years, women have been treated based on diagnostics created for men.
And surveys of available data show
that a very small percentage of research dollars
spent in the US focus on the treatment of women with heart disease.
So what is wrong with this picture?
What is wrong with this picture is the outrageous gender inequality
that women face in the treatment of heart disease.
I consider myself a well informed person, sort of
(Giggles)
but when I heard these facts, I was stunned.
Very few people seem to know this
and until recently,
almost no one talked about or paid attention to an epidemic
that women are dying from throughout the world.
Women have made enormous strides.
We have had women explore the depths of outer space,
a woman has run for President of the US,
and a woman has served as a Speaker of the House.
Yet, a boys' club still exists in the medical sciences.
When I learned this, I knew I had to get involved
and try to do something to change this picture.
I believe that those with a platform in the entertainment industry
have the privilege of being able
to speak out against inequality, discrimination and injustice.
And that's why I have chosen to speak out on this issue.
The number of women dying from breast cancer
has significantly declined over the years
because of people speaking out, sharing their stories,
and the enormous amount of money
that is raised for research and early detection efforts.
Last year, an estimated $1.7 billion was raised for breast cancer alone,
and that's great.
But only a small fraction of that amount was raised for women's heart disease.
We desperately need the same kind of coordinated campaign.
So, in 2008, I endowed a research and education programme
at Cedars-Sinai Women's Heart Center
under the leadership of Dr. Noel Bairey Merz
who was doing life-saving work in this field.
Throughout my life, gender inequality has always concerned me,
whether it is making a movie about it or becoming involved in women's issues.
And in this case gender really does matter when it comes to medical science.
How can you treat a woman for a life-threatening ailment
based on research done on men?
Especially when women's hearts
are physiologically different than men's hearts?
Women tend to have blockages, not only in their main arteries
but also in the smaller arteries that supply blood to the heart,
a condition called microvascular disease,
and you will hear more about that from Dr Merz.
Because of this, heart disease presents very differently in women than in men.
71% of women experience early warning signs of a heart attack
with sudden onset of extreme weakness that feels like the flu,
often with no chess pain at all, unlike the Hollywood heart attack
we are all accustomed to seeing in movies and television
where the man grips his chest and falls to the floor.
Most women who have heart attack experience nausea,
vomiting, sweating, and light-headedness.
Nearly twp thirds of the deaths from heart attacks in women occur
among those who have no history of chest pain.
Most women do not know this and often times,
by the time they enter the emergency room,
their hearts have suffered substantial damage.
Even if they go to their doctor who is well-intentioned,
they are often misdiagnosed.
I have met patients who have consulted two or three cardiologists
and they are still misdiagnosed
because many doctors are not given the proper training
to know the warning signs in women.
Heart research done on women also helps men as well.
Take stem cell research for example.
Recently, Dr. Merz and I were talking about the work of a colleague
who was trying to grow the first human heart in a petri dish.
She had a breakthrough in her study when she found out
that using only female stem cells was the solution.
(Laughter)
How powerful is that, girls?
(Applause)
Because she discovered that using male stem cells did not work.
They got totally lost.
(Laughter)
This is true.
And as we know, men, even male stem cells, won't ask for directions.
(Laughter)
(Applause)
It's true. Funny but true!
(Laughter)
So, joking aside, the heart is an amazing organ.
And first and foremost, we need to focus on prevention.
Women's lives are becoming increasingly demanding
as they juggle the responsibilities of being wife, mother,
and helping to support the family.
We need to take better care of ourselves.
We need to slow down, reduce stress, eat better, make time for exercise.
Because the heart is a precious organ that needs to be protected.
Recently, I read an article authored by sociology professor Mitch Hall.
And I found that his insights,
which are reinforced by various academic sources
are really fascinating.
So, I am going to quote a few here.
He wrote: "As we develop in the utero,
the human heart is the first organ to begin forming.
In traditional Chinese medicine, the inner spiritual core of the self
is deemed to reside not in the head but in the heart."
He goes on to say: "the heart is not just pump, what it does is listen."
He suggests that: "the heart senses and integrates our thoughts, our emotions
and our will to carry out tasks.
The heart actually is a sensitive integrator of all our experience.
Ancient cultures saw the heart as the seed of the soul.
A human being has dual hearts,
the first, a pulsating fist of muscle in the chest,
the second, a precious cabal of communicating neurons
that create feeling, longing and love.
Many idioms attest to this second heart, the social emotional heart.
For instance, sorrow is 'heartbreak, ' sincere intentions are 'heart-felt.'
Compassionate is to be 'open-hearted' devoid of compassion, 'heartless, '
to 'follow one's heart' means to act on the basis of an intuitive sense
of one's own most fulfilling option."
He closes by saying: "To hearten is to 'encourage, '
and our English word 'courage'
is itself derived from the French word 'coeur, ' meaning heart."
Which brings me to the reason I am here today,
to introduce a woman with a big one, a big heart that is!
(Laughter)
And a thin body!
(Laughter)
[I am] envious.
Dr. Noel Bairey Merz!
She is the Director of Women's Heart Center at Cedars-Sinai
and is helping to lead the way
enclosing the 50-year research gap in women's heart disease.
She is a Harvard Medical School graduate,
has published over 180 specific publications
and has received numerous awards recognizing her
as one of the field's leading experts on preventive cardiology,
women's heart disease and mental stress.
She is an amazing woman who can juggle a hundred different things all at once
and still have time to raise a beautiful family.
I was thrilled when I heard
that this brilliant woman was doing life-saving work
that would ultimately impact women all over the world,
right in our own backyard here at Cedars-Sinai Medical Center.
We can no longer afford to naively assume that heart disease is only a men's disease
because as I mentioned earlier, it's now an epidemic facing women.
So, I want to thank Dr Merz for the work she is doing
to help women live longer and healthier lives,
women we love, our mothers, daughters,
sisters, aunts, wives, and friends.
And with that, it's my honor to introduce
the remarkable Dr. Noel Bairey Merz!
(Music) [Relationships]
Noel Bairey Merz: Thank you so much and thank you Barbara.
As usual, your leadership in our work together is clearly saving lives.
I am here in this session about relationships
to talk about your relationship with your heart.
And too often, women are not thinking about their hearts,
so it's a critically important relationship.
Look to your left, look to your right.
One out of two of you women will be impacted
by cardiovascular disease in your life-time.
So, this is the leading killer of women.
It is a closely-held secret for reasons I do not know.
As you know I am a cardiologist.
In addition to making this personal,
so we are going to talk about your relationship with your heart
and all women's relationships with their heart,
we are going to wax into the politics because the personal 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.
So, from since 1984,
more women now die in the US than men
so where we used to think of heart disease as being a men's problem primarily,
which was never true but that was kind of how everybody thought in the 1950s and 60s
and it was in all the textbooks,
it is certainly what I learned when I was training.
It is actually a woman's disease.
So it is a woman's disease now.
And one of the things that you see is that male line,
the mortality is going 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 a 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?
were not 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 campaign again, this is not a competition,
we are 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 cannot think of a young woman who has heart disease.
I am going to tell you why!
Heart disease kills people, often very quickly.
So the first time heart disease strikes in women and men,
but we are talking about women today,
half of the time, it is 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.
[In] breast cancer, mortality is down to 4%
and that is the 40 years that women have advocated.
Betty Ford, Nancy Reagan stood up and said I am a breast cancer survivor
and it was OK to talk about it and then physicians have gone to the bed.
We have done the research. We have effective therapies now.
Women are living longer than ever.
That has to happen in heart disease, and it is time.
It is not happening and it is time.
We owe an incredible debt and gratitude to these two women.
I know I got another web.
(Laughter)
As Barbara depicted in one of her amazing movies 'Yentl',
in order to get treated like a man,
she portrayed a young woman who wanted an education.
She wanted to study the Talmud.
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 that she could have the same rights that the man had.
Bernardine Healy, Dr. Healy is a cardiologist
and right around that time, in the 1980s,
that we saw women and heart disease deaths going up and up,
she wrote an editorial in the New England Journal of Medicine
and said "the Yentl syndrome"
[that's] women are dying of heart disease two, three, four times more than men.
Mortality is not going down, it's going up,
and she hypothesized "Is this a Yentl syndrome?"
And here is what the story is.
It is because women don't look like men, they don't look like
that male pattern heart disease
that we have spent the last 50 years understanding
and getting really good diagnostics and really good therapeutics.
And therefore, they are not recognised for their heart disease
and they just pass.
They do not get treated, they do not get detected,
they do not get the benefit of all the modern medicine.
Dr Heale then subsequently became the first female director
of our National Institutes of Health.
And this is the biggest biomedical enterprise research in the world.
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.
In the face of a lot of controversy, she started the Women's Health Initiative.
Every woman in the room here has benefited from that Woman's Health Initiative.
It told us about hormone replacement therapy,
it has informed us about osteoporosis, breast cancer and colon cancer in women.
Tremendous fund of knowledge despite, again,
that so many people told her not to do it.
It was too expensive and the underwriting was [that] women are not worth it.
She was like:"No, sorry. Women are worth it."
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 it stands for Women's Ischemia Syndrome Evaluation,
and I have chaired this study for the last 15 years.
It was the 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
[that]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 millions of people; happening everyday,
women in their fatty plaque, and this is their coronary arteries
[where] the main blood supply [is] going into the heart muscle
women erode, men explode.
You are going to find some interesting analogies in this physiology.
(Laughter)
I will describe the male pattern heart attack first,
the Hollywood heart attack, ahhhh!
Horrible chest pain, EKG goes boom!
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's heart attack.
Some women have those heart attacks but a whole bunch of women
have this kind of heart attack
where the roads [do] not completely fill with clot.
Symptoms are subtle, EKG findings are different.
Female pattern.
So what do you think happens to these girls?
They are often not recognised, sent home.
I am not sure what it was. It might have been gas.
So, we picked up on that and said [that] we now have the ability
to look inside human beings with special catheters
called IVUS, intravascular ultrasound.
And we said we are 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 is just a focal... right there!
Where do women get fat? All over!
(Laughter)
Cellulite here, cellulite here!
So, women look like they are pretty good about putting the garbage away
smoothly putting it away.
Men just have to dump it in a single area.
So we said, let's look at this, and so the yellow is the fatty plaque,
and panel A is a man and you can see it is lumpy bumpy.
He has got a beer belly in his coronary arteries.
Panel B is the woman, very smooth, she has just laid it down, nice and tidy.
(Laughter)
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.
It is kind of hard to see that female pattern disease!
So that was a discovery, and 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 were pretty good
at recognizing male pattern disease with stress tests.
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,
an about 2.5 years into a 5-year study.
This was the only modality that can see the inner lining of the heart.
If you look carefully you can see that there is a black lash right there
and that is macrovascular obstruction.
The syndrome, the female pattern is called
Microvascular Coronary Dysfunction or obstruction.
The second reason we really like the MRI is that there is no radiation.
So, unlike the CAT scans, Xrays, 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 are very excited about MR.
You cannot 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.
What are the consequences?
(Laughter)
We got these from Barbara.
(Laughter)
You approved it.
Then, what are the downstream consequences
when female pattern heart disease is not recognised?
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 show why more women are dying of heart disease
despite these good treatments that we know and we have worked?
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 do not 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 is in fact explaining a lot of these gaps.
There has been wonderful news also about studying women,
finally, in heart disease!
One of the cutting edge areas that we are just incredibly excited about
is stem cell therapy.
Women, you might imagine, 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.
Men don't. They participate, sort of.
(Laughter)
But [only] women can generate a new life and can remodel,
can put the garbage where it needs to be,
makes a new thing, new baby, baby comes out.
And that is all stem cells.
So, we hypothesize 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 are trying to do
with stem cell therapy.
These are female and male stem cells.
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 are out to lunch?
(Laughter)
Some of our investigative teams had demonstrated that female stem cells
and this is in animals, and increasingly in humans
that female stem cells, when put even into a male body, do better
than male stem cells into a male body.
One of the things that we say about all of this female physiology,
because again as much as we are 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 women.
So this is not a zero sum scam in any way.
So here is 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 curb.
So, just like the breast cancer story, doing research, getting awareness going,
it works, you just have to get it going!
Are we happy with this?
We still have two to three more women dying for every man.
And I'd propose with the better longevity that women have overall
that just making this equal, I think, is probably not going to be the truth
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 have worked on this for 15 years, and I have told you,
we have been working on male pattern heart disease for 50 years.
So we are 35 years behind and we'd like to think it is not going to take 35 years
and in fact it probably won't.
But we cannot stop now. Too many lives are at stake.
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 at getting mammograms now and they do fund raising.
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 and it is political.
Women's health from a federal funding standpoint,
sometimes is popular, sometimes it is not so popular.
So we have these feast and famine cycles.
So I implore you to join the red dress campaign
There is the heart truth which is the red dress.
Go get a pin and you can get them from our Women's Heart Center
from National Heart Lung and Blood over the American Heart.
Please join Barbara in this fund raising.
We need to be as good, if not better, than breast cancer.
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.
(Applause)