will be impacted by cardiovascular disease

在座的女性，有二分之一的妳們

in your lifetime.

在妳們的一生當中

So this is the leading killer of women.

將會遭受到心臟血管疾病

It's a closely held secret

所以我們可以說它是女性的頭號殺手

for reasons I don't know.

但這卻是一個沒有被公開秘密

In addition to making this personal --

我也不知道為什麼

so we're going to talk about your relationship with your heart

除了讓這個訊息涉及到每一個人身上以外

and all women's relationship with their heart --

我們當然會先討論妳和妳心臟之間的關係

we're going to wax into the politics.

還有所有女性與她們心臟之間的關係

Because the personal, as you know, is political.

接著，我們還要把它擴及到政治上面

And not enough is being done about this.

畢竟，涉及個人私事的事情，通常也都是政治化的

And as we have watched women

至今人們對此做的還不夠

conquer breast cancer

但因為我們都曾經看過

through the breast cancer campaign,

看過女性在乳癌相關活動中

this is what we need to do now with heart.

戰勝乳癌的例子

Since 1984,

這就是現階段我們必須要對心臟做的事情

more women die in the U.S. than men.

自從1984年以來

So where we used to think of heart disease

在美國女性因為心臟疾病死亡的人數大於男性

as being a man's problem primarily --

過去我們一直認為

which that was never true,

「心血管疾病主要是男性的疾病」

but that was kind of how everybody thought in the 1950s and '60s,

其實一直都不是真的

and it was in all the textbooks.

但在1950、60的年代，幾乎所有人都這麼覺得

It's certainly what I learned when I was training.

連教科書上也都這麼說

If we were to remain sexist, and that was not right,

可以肯定的是在我就學階段我是這樣被教育的

but if we were going to go forward and be sexist,

如果我們是想要維持性別主義的話，那這個論點是錯的

it's actually a woman's disease.

但如果我們想要有所進步並且同時維持性別主義的話

So it's a woman's disease now.

心血管疾病其實是女性的疾病

And one of the things that you see

所以，這現在是女性的疾病了

is that male line,

你們可以發現一件事

the mortality is going down, down, down, down, down.

在男性的趨勢線上面

And you see the female line since 1984,

死亡率一直不斷的下降，下降，下降

the gap is widening.

接著再看到1984年以來的女性死亡率

More and more women, two, three, four times more women,

與男性的差距不斷擴大

dying of heart disease than men.

越來越多的女性，以兩倍到三倍到四倍

And that's too short of a time period

的差距遠勝於男性因心臟疾病的死亡率

for all the different risk factors that we know

而在那麼短的時間內

to change.

據我們所知，就算所有的危險因子加在一起

So what this really suggested to us

也不足以做出改變

at the national level

所以，這個圖表真正帶給我們的啟發是

was that diagnostic and therapeutic strategies,

以整體而言

which had been developed in men, by men, for men

在過去五十年來

for the last 50 years --

所有國內的診斷和治療策略

and they work pretty well in men, don't they? --

都是在男性身上，並且針對男性而發明的

weren't working so well for women.

而且也都還滿有效的，對吧?

So that was a big wake-up call

但對於女性來說就沒這麼有效了

in the 1980's.

所以，在80年代的時候

Heart disease kills more women

這個數據喚起了大家的重視

at all ages

那就是，心臟疾病對各個女性朋友們的年齡層來說

than breast cancer.

都比乳癌

And the breast cancer campaign --

來得致命

again, this is not a competition.

關於乳癌防治推廣運動

We're trying to be as good as the breast cancer campaign.

當然，這不是競賽

We need to be as good as the breast cancer campaign

我們試著要做得跟乳癌防治運動一樣好

to address this crisis.

我們必須要做得跟乳癌防治運動一樣好

Now sometimes when people see this,

才可以對付這個危機

I hear this gasp.

有時候當人們看見這個圖表的時候

We can all think of someone,

我會聽見倒吸氣的聲音

often a young woman,

我們常常都可以聯想到某個人

who has been impacted by breast cancer.

經常是一位年輕女性

We often can't think of a young woman

遭受了乳癌的折磨

who has heart disease.

但我們卻很少聯想到某個年輕女性

I'm going to tell you why.

得到心臟疾病

Heart disease kills people,

讓我來告訴你們為什麼

often very quickly.

心臟疾病是會致命的

So the first time heart disease strikes in women and men,

而且通常在很短的時間內

half of the time it's sudden cardiac death --

所以當人們第一次心臟病發的時候

no opportunity to say good-bye,

有一半以上的機會立即造成心肌梗塞死亡

no opportunity to take her to the chemotherapy,

讓人沒有機會說再見

no opportunity to help her pick out a wig.

沒有機會帶她去做化療

Breast cancer,

也沒有機會幫她挑選假髮

mortality is down to four percent.

乳癌

And that is the 40 years

致死率降到只有4%

that women have advocated.

這是過去40年來

Betty Ford, Nancy Reagan stood up

女性不斷倡導的結果

and said, "I'm a breast cancer survivor,"

貝蒂芙特，南西雷根都公開站出來

and it was okay to talk about it.

說過：「我是乳癌的生還者!」

And then physicians have gone to bat.

這不是禁忌的話題

We've done the research.

接著醫師們就開始研究討論

We have effective therapies now.

我們完成了研究

Women are living longer than ever.

我們發明了有效的療法

That has to happen in heart disease, and it's time.

於是女性們活得比之前都更久

It's not happening, and it's time.

這些事也必須在心臟疾病的領域裡發生，而且該是時候了!

We owe an incredible debt of gratitude

是時候了，然而我們卻還未這麼做。

to these two women.

我們該將莫大的感謝

As Barbara depicted

給這兩位女性

in one of her amazing movies, "Yentl,"

芭芭拉

she portrayed a young woman

在她一部令人驚豔的電影 「楊朵」 裡面

who wanted an education.

詮釋了一位

And she wanted to study the Talmud.

渴望教育的年輕女性

And so how did she get educated then?

她想要學塔木德經

She had to impersonate a man.

所以最後她如何得到教育呢?

She had to look like a man.

她必須要扮演成一位男性

She had to make other people believe that she looked like a man

必須要看起來就像一位男性

and she could have the same rights

她必須要讓別人相信她就像一位男性

that the men had.

並且她可以擁有的權利

Bernadine Healy, Dr. Healy,

跟男性同等

was a cardiologist.

伯纳丁•希利博士

And right around that time, in the 1980's,

是一位心臟病專家

that we saw women and heart disease deaths

就在那個時候 1980年代

going up, up, up, up, up,

當我們看見女性跟心臟病的死亡率

she wrote an editorial

不斷不斷升高的時候

in the New England Journal of Medicine

她寫了一篇文章

and said, the Yentl syndrome.

發表在新英格蘭醫學雜誌上

Women are dying of heart disease,

她說，這就是「楊朵症狀」

two, three, four times more than men.

女性死於心臟的比例

Mortality is not going down, it's going up.

比男性多兩、三、四倍

And she questioned,

而死亡率並不是在下降而是在上升

she hypothesized,

她於是提出疑問

is this a Yentl syndrome?

她做了假設

And here's what the story is.

這就是「楊朵症狀」嗎?

Is it because women don't look like men,

故事是這樣的

they don't look like that male-pattern heart disease

是不是因為女性不像男性

that we've spent the last 50 years understanding

也不像那些我們花了過去五十年

and getting really good diagnostics

得到良好診斷

and really good therapeutics,

和完善治療系統

and therefore, they're not recognized for their heart disease.

的男性心臟疾病模式

And they're just passed.

所以女性的心臟疾病沒有被認出來

They don't get treated, they don't get detected,

就這樣被忽略了

they don't get the benefit of all the modern medicines.

於是她們沒有得到治療，沒有被檢查出來

Doctor Healy then subsequently became

所以現代的藥物也無法對她們帶來一點好處

the first female director

希利醫生接著成為了

of our National Institutes of Health.

第一位女性的

And this is the biggest biomedical enterprise research

美國國家衛生研究院院長

in the world.

這是最具權威的生物醫學研究機構

And it funds a lot of my research.

在全世界

It funds research all over the place.

它資助了很多我的研究

It was a very big deal

它在各地都有資助研究

for her to become director.

這是一個很重大的決定

And she started,

讓她成為院長

in the face of a lot of controversy,

而她首先

the Women's Health Initiative.

在一片爭議聲浪中

And every woman in the room here

首先提出了婦女健康關懷研究 (WHI)

has benefited from that Women's Health Initiative.

所有在座的每一位女性

It told us about hormone replacement therapy.

都曾經受惠於這個WHI

It's informed us about osteoporosis.

它告訴我們荷爾蒙替代療法

It informed us about breast cancer, colon cancer in women.

也告訴了我們骨質疏鬆症

So a tremendous fund of knowledge

它告訴了我們關於發生在女性身上的乳癌、大腸癌

despite, again,

這些都需要鉅額的贊助

that so many people told her not to do it,

儘管，

it was too expensive.

很多人告訴她不要這麼做

And the under-reading was women aren't worth it.

花費太高了

She was like, "Nope. Sorry. Women are worth it."

這背後暗喻著大家覺得女性不值得這筆研究花費

Well there was a little piece of that Women's Health Initiative

但她卻說「不，不好意思，女性值得我們這麼做」

that went to National Heart, Lung, and Blood Institute,

婦女健康關懷研究(WHI)有一小部份的領域

which is the cardiology part of the NIH.

歸屬於國家心臟肺和血液研究所

And we got to do the WISE study --

這個研究所是國家衛生研究院的心血管部門

and the WISE stands for Women's Ischemia Syndrome Evaluation --

我們當時要進行WISE研究

and I have chaired this study for the last 15 years.

WISE代表婦女缺血綜合症評估

It was a study to specifically ask,

過去十五年我一直領導著這個研究

what's going on with women?

這研究的主題是

Why are more and more women dying

女性到底怎麼了?

of ischemic heart disease?

為什麼會有越來越多的女性死於

So in the WISE, 15 years ago,

缺血性心臟病?

we started out and said, "Well wow, there's a couple of key observations

所以十五年前在研究WISE時

and we should probably follow up on that."

我們開始想「哇，的確是有幾個關鍵的發現

And our colleagues in Washington, D.C.

我們應該繼續追根究柢」

had recently published

我們在華盛頓DC的同事

that when women have heart attacks and die,

當時剛發表了

compared to men who have heart attacks and die --

當女性遇到心臟病發作而死亡

and again, this is millions of people,

與男性心臟病發死亡的比較

happening every day --

再一次，這事關上百萬的人

women, in their fatty plaque --

而且天天都在發生

and this is their coronary artery,

女性，在她們的脂肪斑裡

so the main blood supply going into the heart muscle --

這個是她們的冠狀動脈

women erode,

心臟肌肉主要的血液供給從這裡來的

men explode.

女性收縮

You're going to find some interesting analogies

而男性則是迅速膨脹擴大

in this physiology.

你會發現一些其他有趣的相似之處

(Laughter)

在生理學裡面

So I'll describe the male-pattern heart attack first.

(笑聲)

Hollywood heart attack. Ughhhh.

我首先來描述一下男性心臟病發作的型態

Horrible chest pain.

好萊屋式的心臟病 厄….

EKG goes pbbrrhh,

很嚴重的胸痛

so the doctors can see this hugely abnormal EKG.

心電圖 嗶嗶嗶

There's a big clot in the middle of the artery.

所以醫生能夠看見極度不正常的心電圖

And they go up to the cath lab

在冠狀動脈的中間有一個很大的凝塊

and boom, boom, boom get rid of the clot.

於是他們前往心導管實驗室

That's a man heart attack.

然後迅速移除凝塊

Some women have those heart attacks,

這是男性典型的心臟病發作

but a whole bunch of women have this kind of heart attack,

有些女性也有這種型態的心臟病發作

where it erodes,

但絕大部分女性的心臟病發作型態都像這樣

doesn't completely fill with clot, symptoms are subtle,

它收縮

EKG findings are different --

不完全填滿凝塊，症狀不太容易被發覺

female-pattern.

心電圖的偵測也不一樣

So what do you think happens to these gals?

這是女性型態的

They're often not recognized, sent home.

所以你們覺得對於這些女性接下來會發生什麼事情?

I'm not sure what it was. Might have been gas.

他們經常沒有被發現到，於是就被送回家

So we picked up on that

我也不太確定這是什麼，應該是胃脹氣吧？

and we said, "You know, we now have the ability

所以我們選擇繼續研究

to look inside human beings

然後我們想「你知道嗎 ? 我們現在有能力

with these special catheters called IVUS:

看人體的內部

intravascular ultrasound."

透過這些叫做IVUS的特別導管看人體的內部

And we said, "We're going to hypothesize

血管內超音波」

that the fatty plaque in women

然後我們說「我們要來假設

is actually probably different,

女性的脂肪斑

and deposited differently, than men."

跟男性的比起來，

And because of the common knowledge

其實大有不同、沉澱方法也不同。」

of how women and men get fat.

又因為我們一般

When we watch people become obese,

對於男女性增胖的認知

where do men get fat?

當我們看人們變胖的時候

Right here, it's just a focal -- right there.

男性都在哪裡發胖?

Where do women get fat?

就在這，只是局部的，就在那

All over.

女性在哪裡發胖?

Cellulite here, cellulite here.

到處…

So we said, "Look, women look like they're pretty good

這裡是脂肪、這裡也是脂肪

about putting kind of the garbage away,

所以我們想說「你看，女性看起來

smoothly putting it away.

還蠻會處理廢棄物的

Men just have to dump it in a single area."

緩緩地把它們弄開

So we said, "Let's look at these."

男性就隨手丟在同一個區域」

And so the yellow is the fatty plaque,

所以我們來看看這個吧!

and panel A is a man.

黃色的部分是脂肪班

And you can see, it's lumpy bumpy.

A版塊是男性

He's got a beer belly in his coronary arteries.

你可以看見這是塊狀沉著物

Panel B is the woman, very smooth.

它在他的冠狀動脈裡面有一個很大的啤酒肚

She's just laid it down nice and tidy.

B版塊是女性，非常平滑

(Laughter)

她只是非常溫柔而且整潔的躺下

And if you did that angiogram,

(笑聲)

which is the red,

而如果你做了這個血管攝影

you can see the man's disease.

紅色的

So 50 years

你就會發現男性的疾病

of honing and crafting these angiograms,

所以50年來

we easily recognize

對於這些血管攝影的琢磨

male-pattern disease.

我們可以輕易的就認出

Kind of hard to see that female-pattern disease.

男性型態的疾病

So that was a discovery.

但是女型疾病的形態卻很難被確立

Now what are the implications of that?

這是一個重大發現

Well once again, women get the angiogram

那麼影響會是什麼呢?

and nobody can tell that they have a problem.

又再一次，女性照了血管攝影

So we are working now on a non-invasive --

但沒人能夠指出她們是否有問題

again, these are all invasive studies.

所以我們現在往非手術式的方向研究

Ideally you would love to do all this non-invasively.

再一次，這些都是手術研究

And again, 50 years

理想上來說你們當然會比較喜歡非手術式的

of good non-invasive stress testing,

經過50年來

we're pretty good at recognizing male-pattern disease

良好的非手術式壓力研究

with stress tests.

我們已經能夠不錯的透過這個測試

So this is cardiac magnetic resonance imaging.

辨識男性疾病的形態

We're doing this at the Cedars-Sinai Heart Institute

這是心臟病患者的核磁共振成像

in the Women's Heart Center.

我們在Cedars-Sinai心臟機構的

We selected this for the research.

女性心臟中心做的

This is not in your community hospital,

我們選擇這張做為研究

but we would hope to translate this.

這不是一般的社區醫院

And we're about two and a half years

但我們還是希望能夠解讀它

into a five-year study.

在五年的研究內

This was the only modality

我們已經做了兩年半

that can see the inner lining of the heart.

這是唯一的方法

And if you look carefully, you can see

讓我們可以看到心臟裡層的

that there's a black blush right there.

如果你看得更仔細一點，會發現

And that is microvascular obstruction.

那裡有一個黑塊

The syndrome, the female-pattern

那就是微血管堵塞

now is called microvascular coronary dysfunction, or obstruction.

這個女性型態的併發症

The second reason we really liked MRI

現在稱為，冠狀動脈微血管喪失官能障礙，或堵塞

is that there's no radiation.

第二個我們現在很喜歡核磁共振的原因

So unlike the CAT scans, X-rays, thalliums,

是因為它沒有輻射

for women

不像電腦斷層掃描、X光、鉈201心肌血流灌注掃瞄檢查