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.?

二分之一的女性一生中會受到心血管疾病的影響。這是女性的頭號殺手。我不知道為什么不為人所知。除了針對個人以外--我們要談?wù)撃闩c你心臟的關(guān)系，所有女性與心臟的關(guān)系--我們要鑄進政治中去。

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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.

因為個人呢，也是政治化的。在這一點上做得還不夠。我們都曾經(jīng)見過借助乳腺癌的宣傳女性在征服乳腺癌。現(xiàn)在我們也應(yīng)當(dāng)這樣來對待我們的心臟。

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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.?

從1984年以來在美國，女性的死亡率高于男性。我們那時都習(xí)慣認為心臟病是男性的主要問題——其實從來就不正確。但20世紀(jì)五，六十年代人人都這樣認為，并且課本里都是這樣的。

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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.?

我受訓(xùn)的時候就是這樣學(xué)的。五六十年代那種含有性別歧視色彩的觀點是不對的?？墒?，為了討論這個問題，就讓我們站在女性立場上吧。心臟疾病實際就是女性的疾病。現(xiàn)在是女性的疾病。

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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.?

有一件事情你看到的是，這條男性線上的死亡率一直在下降，下降，下降。從1984年來，女性這條線，差距在加寬。越來越多的女性，死于心臟疾病的比男性多兩倍，三倍或四倍。

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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.?

在這個太短的時間內(nèi)，我們有諸多的不同威脅因素要改變。所以，這就建議我們采取國家級別的診斷和治療策略，因為在過去的50年里曾被男性開發(fā)，也為男性服務(wù)，它們也起了很好的作用，是不是？但，女性們沒得到什么好處。那是80年代的一個大警鐘。

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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.?

無論哪個年齡段，女性的心臟病死亡率都高于乳腺癌。雖然乳腺癌作了宣傳活動，但這不是競爭。我們要做像乳腺癌同樣好的宣傳活動。我們需要做和乳腺癌同樣好的活動來解決這場危機。

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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.?

有時，人們看到這些就會嘆氣。我們可以想到某個人，常常是一位很年輕的婦女會受乳腺癌的影響。我們卻不會想到一位年輕的婦女會得心臟病。我要告訴大家為什么這樣。心臟病發(fā)作死亡，經(jīng)常很快。

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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.?

所以心臟病第一次襲擊男性和女性，半數(shù)是心源性猝死--沒機會說再見，沒機會帶她去做化療，沒機會幫她挑選假發(fā)。

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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.?

乳腺癌死亡率下降了4個百分點。這就是40年來婦女呼吁的結(jié)果。貝蒂?福特，南希.里根曾經(jīng)站起來說：“我是乳腺癌的幸存者，”這是可以談?wù)摰摹?/p>

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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.?

于是，醫(yī)師們就去著手。我們做了調(diào)查。我們現(xiàn)在擁有有效的療法。女性比以前更長壽。對待心臟病也應(yīng)該這樣，是時候了?，F(xiàn)在還沒做什么，是時候了。

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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.?

我們對這兩位女性欠下感激之債。就像芭芭拉在她的一部很棒的電影《燕特爾》“Yentl”里刻畫了一位年輕的女性想要受教育。她想學(xué)習(xí)猶太法典。?

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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.?

那她怎么樣接受的教育呢？她必需得裝扮成男人。她必需看上去像個男人。她必需讓別人相信她像個男人，她有男人該有的同樣的權(quán)利。伯納丁·希利，希利醫(yī)師是個心臟病學(xué)家。

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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??

當(dāng)時是1980年代，我們看到女性心臟病死亡一直上升，上升，上升，她在新英格蘭醫(yī)學(xué)雜志上寫了一篇社論，說到燕特爾綜合癥。死于心臟病的女性是男性的兩倍，三倍或四倍。死亡率沒有下降，而在上升。她質(zhì)疑過，她假設(shè)過這是一種燕特爾綜合癥嗎？

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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。因為女性長的不像男性，她們的心臟病不像男性模式，她們沒有我們研究了50年而理解的真正好的診斷和真正好的治療。因此，她們的心臟病沒被公認。她們就這樣走了。她們沒得到醫(yī)治，她們沒被檢測，她們沒有得益于所有的現(xiàn)代醫(yī)藥。

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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.?

希利醫(yī)師后來成為美國國家衛(wèi)生部的首位女部長。這是世界上最大的生物醫(yī)學(xué)企業(yè)研究。我的許多研究是由它贊助的。它贊助的研究到處都有。她當(dāng)部長是很轟動一時的。

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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.?

她開始的時候，面臨了許多對女性健康倡議的爭議。在座的每一位女性都得益于婦女健康倡議。它告訴我們激素替代療法。它告訴我們骨質(zhì)疏松癥。它告訴我們女性的乳腺癌，大腸癌。

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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."?

盡管有巨大的知識積累，但還是有許多人告訴她不要去做，因為它太昂貴了。字里行間是說女性不值得。她當(dāng)時說，“不是，抱歉，女性是值得的?！?

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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.?

于是有一小部分的婦女健康倡議，進入到國家心臟，肺和血液研究所就是國家衛(wèi)生研究院的心臟學(xué)部分。我們?nèi)プ龅腤ISE研究--WISE代表婦女缺血綜合癥評估--我已經(jīng)主持這項研究達15年之久。

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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."?

這個研究在明確地問，婦女到底怎么了？為什么越來越多的女性死于缺鐵性心臟病，15年前，在婦女缺血綜合癥評估里，我們開始說：“好哇，有幾個關(guān)鍵的意見，我們也許應(yīng)該跟進觀察?！?

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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.?

在華盛頓特區(qū)，我們的同行們最近發(fā)表文章，把女性和男性因心臟病致死做了比較——仍有成千上萬的人每天還在發(fā)生——女性在她們的脂肪斑塊里這是冠狀動脈，主要的血液供應(yīng)進到心臟肌肉時，女性是受侵蝕式，男性是爆炸式。你們會在生理學(xué)上找到些有趣的相似。

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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.?

我先來描述一下男性模式的心臟病發(fā)作。好萊塢式的心臟病發(fā)作。啊......可怕的胸口痛。心電圖一下子跳上去，所以醫(yī)生看到的是巨大的異常心電圖。動脈當(dāng)中有一個大的血塊。他們?nèi)サ叫膶?dǎo)管室，嘭嘭嘭就把血塊拿掉。

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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.?

那是男性的心臟病發(fā)作。有些女性也是這樣，但很多的婦女的心臟病發(fā)作是，動脈受到侵蝕但沒有完全被血塊阻塞，癥狀不明顯，心電圖也不一樣——這就是女性模式。這些女性會怎么樣呢？經(jīng)常是，她們沒被識別為心臟病發(fā)作，而被送回家。我不清楚是什么?？赡苁莾?nèi)部有氣體。

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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."?

所以我們會注意到，說，“我們現(xiàn)在有能力用這些特殊的叫做IVUS的管道來透視人體內(nèi)部：血管內(nèi)超聲檢查?！蔽覀冋f，“我們要假設(shè)女性體內(nèi)的脂肪斑塊與男性的不同，并且存積方式也不同?！?

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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.?

根據(jù)男女如何變胖的常識。當(dāng)我們看到人發(fā)福，男性胖在哪兒呢？就在這，就一個焦點--這里。女性胖到哪兒呢？全身都是。這里一塊贅肉，這里一團脂肪。

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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."?

因此我們說：“看哪，女人們很會把這些垃圾分散好，分得很順利。男人只能倒進一個地方。”我們說，“來看看這些?！?

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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.?

黃色是脂肪斑塊，A組是男人。你能看到，是波浪不平的。在他的冠狀動脈里長了個啤酒肚。B組是女性，非常平滑。她把它擺得整潔漂亮。

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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.

如果你做過血管造影，就是這個紅色，你可以看到男性的疾病。經(jīng)過50年的磨練和制作這些血管造影，我們很容易認出男性模式的疾病。但難于看到女性模式的疾病。所以，才有了個發(fā)現(xiàn)。言外之意是什么呢？就是，女性也做血管造影片，但沒有人能告訴她們有問題。

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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.?

我們在著手于一個非侵略性的研究——事實上，這些研究都是侵略性的。最理想的是，你會想用非侵入法來做這些研究。再重復(fù)一遍，五十年的很好的非侵入的壓力測試，我們很在行從這些測試中認出男性模式的疾病。這就是心臟磁共振成像。?

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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.?

我們在婦女心臟中心的雪松西奈山心臟中心做這些研究。我們?yōu)檫@項研究做了選擇。這雖然不是你的社區(qū)醫(yī)院，我們希望能傳遞相同的信息。我們?yōu)槠?年的研究已進行了一半。

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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.?

這是能看到心臟內(nèi)膜的唯一模式。如果你仔細看，會看到這里有個黑黑的血塊。那就是微血管阻塞。這種女性模式的癥狀就叫做冠狀動脈微血管功能障礙或阻塞。

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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?"?

我們喜歡核磁共振成像的第二個原因是它沒有輻射。不像計算機輔助測試掃描，X光片，鉈掃描等因為女性每次做心臟測試都會考慮對乳房的影響，哪怕小數(shù)量的輻射， 我們也會說：“真有做這個測試的必要嗎？”?

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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.?

我們對核磁共振非常興奮。你們還不能現(xiàn)在就去使用它，但這是個積極探究的領(lǐng)域， 對女性的研究將推進男性和女性的領(lǐng)域。?

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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.?

女性模式心臟病的未被識別的后果是如何呢？這個數(shù)據(jù)是從我去年發(fā)表在歐洲心臟雜志上的一片社論來的。?

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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.?

這個象形圖顯示，盡管我們知道 很多的有效的治療法，為什么還有更多的女性死于心臟病。當(dāng)女性出現(xiàn)男性模式的病癥——就像電影里的芭芭拉一樣，她們才會得到醫(yī)治。

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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.?

當(dāng)你有女性模式的癥狀，但你看上去也是女性就像芭芭拉和她丈夫，他們就得不到醫(yī)治。這些都是挽救生命的療法。這些小紅框子是死亡的。這些是后果。那個是女性模式，并且我們認為燕特爾綜合癥也確實解釋了這些差距。

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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??

對于研究女性方面 有很多好消息，最后終于輪到心臟病了。還有一個讓我們異常興奮的前沿領(lǐng)域是干細胞療法。如果你問，在生理上女性與男性的大的不同之處在哪？為什么會有女性和男性？

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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.?

因為女性把新生命帶到世上。這全是干細胞。我們假定女性干細胞會很好地鑒別損傷，做些細胞修補或產(chǎn)生新的器官，這就是我們正在嘗試用干細胞療法做到的。?

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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??

這就是女性和男性干細胞。如果你的器官受損，或你心臟病發(fā)作，我們想修復(fù)受傷的地方，你想不想最先用這些強健又足夠的干細胞？或者，你想他們這樣無精打采呢？

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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.?

我們的一些調(diào)查團隊曾展示女性干細胞——這是動物的并且在人類也有增長——就是當(dāng)我們把女性干細胞注入男性體內(nèi)，它們比男性干細胞工作得更好。?

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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.?

我們講的 女性生理之一 因為我們在談?wù)撆耘c心臟病，通常女性比男性長壽。揭示和認識女性的生理秘密將會幫助男性和女性。這不是零合的游戲。

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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.?

好，我們從這里開始。請記住，交叉點是在1984年，越來越多的女性死于心臟病。在過去的15年里都做了些什么？這個曲線在打彎。我們在折彎這條曲線。

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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.?

就像乳腺癌的故事，做些調(diào)查，讓更多人認識到，它管用的，我們必須繼續(xù)做下去?，F(xiàn)在我們滿意嗎？女性的死亡率仍是男性的兩到三倍。

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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.?

那我提議，總的來說女性比較長壽，如果我們女性得到醫(yī)治，理論上我們的情況會更好。所以這是我們現(xiàn)在的狀況，更艱巨的在后頭。我們已經(jīng)工作了15年。

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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.?

我也說過，我們在男性心臟病上已花了50年的時間。我們落后了35年。我們愿意相信，不用再花35年的時間。事實上也許不會。現(xiàn)在不能停步。太多生命處于危險。

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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.?

我們需要做什么？希望大家跟你的心臟有個更好的個人關(guān)系。女性聽到了 乳腺癌的呼聲，大家就出來做宣傳活動。

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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.?

女性都知道做乳房X線照片。女性做籌款活動。女性積極參與。她們省吃儉用 她們參加宣傳，她們參加各種活動。我們對于心臟病也要這樣做。

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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.?

這是政治。從聯(lián)邦資金的角度看，女性健康有時是受重視，有時不受重視。這就我們有盛宴和饑荒的循環(huán)。

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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.?

我懇求大家 去參加紅衣活動 的籌款。我們說乳腺癌害死婦女，但心臟病害死更多。所以，如果我們能做得像乳腺癌那樣好，給女性新的任務(wù)，我們會拯救很多生命。?

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So thank you for your attention.

謝謝您的關(guān)注。