One out of two of you women will be impacted by cardiovascular disease in your lifetime.
在座的女性，有二分之一的人，在你们的一生当中将会患上心血管疾病。
So this is the leading killer of women. It's a closely held secret for reasons I don't know.
所以我们可以说它是女性的头号杀手。但这却是一个没有被公开秘密。我也不知道为什么。
In addition to making this personal -- so we're going to talk about your relationship with your heart
除了让这个信息涉及到每一个人身上以外，我们当然会先讨论你和你心脏之间的关系，
and all women's relationship with their heart -- we're going to wax into the politics.
还有所有女性与她们心脏之间的关系，我们还要把它扩及到政治上面。
Because the personal, as you know, is political.
毕竟，涉及个人私事的事情，通常也都是政治化的。
And not enough is being done about this.
至今人们对此做的还不够。
And as we have watched women conquer breast cancer through the breast cancer campaign, this is what we need to do now with heart.
但因为我们都曾经看过女性在乳腺癌相关活动中战胜乳腺癌的例子，这就是现阶段我们必须要对心脏做的事情。
Since 1984, more women die in the U.S. than men.
自从1984年以来，在美国，女性因为心脏疾病死亡的人数要多于男性。
So where we used to think of heart disease as being a man's problem primarily -- which that was never true,
过去我们一直认为，心血管疾病主要是男性的疾病，其实一直以来这都是错误的，
but that was kind of how everybody thought in the 1950s and '60s, and it was in all the textbooks.
但在上世纪五、六十年代，几乎所有人都这么觉得，连教科书上也都这么说。
It's certainly what I learned when I was training.
可以肯定的是在我就学阶段我是这样被教育的。
If we were to remain sexist, and that was not right,
如果我们是想要维持性别主义的话，那这个论点是错的，
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.
但如果我们想要有所进步，并且同时维持性别主义的话，心血管疾病其实是女性的疾病。所以，这现在是女性的疾病了。
And one of the things that you see is that male line, the mortality is going down, down, down, down, down.
你们可以发现一件事，在男性的趋势线上面，死亡率一直不断的下降，下降，下降。
And you see the female line since 1984, the gap is widening.
接着再看1984年以来的女性死亡率，与男性的差距不断扩大。
More and more women, two, three, four times more women, dying of heart disease than men.
越来越多的女性，以两倍到三倍到四倍的差距，远胜于男性因心脏疾病的死亡率。
And that's too short of a time period for all the different risk factors that we know to change.
而在那么短的时间内，据我们所知，就算所有的危险因子加在一起，也不足以做出改变。
So what this really suggested to us at the national level was that diagnostic and therapeutic strategies,
所以，这个图表真正带给我们的启发是，以整体而言，所有国内的诊断和治疗策略，
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?
在过去五十年来，都是在男性身上，并且针对男性而发明的，而且也都还挺有效的，对吧?
weren't working so well for women. So that was a big wake-up call in the 1980's.
但对于女性来说就没这么有效了。所以，在80年代的时候，这个数据唤起了大家的重视。
Heart disease kills more women at all ages than breast cancer.
那就是，心脏疾病对各个年龄层的女性朋友们来说，都比乳腺癌来得致命。
And the breast cancer campaign -- again, this is not a competition.
关于乳腺癌防治推广运动，当然，这不是竞赛。
We're trying to be as good as the breast cancer campaign.
我们试着要做得跟乳腺癌防治运动一样好。
We need to be as good as the breast cancer campaign to address this crisis.
我们必须要做得跟乳腺癌防治运动一样好，才可以应付这个危机。
Now sometimes when people see this, I hear this gasp.
有时候当人们看见这个图表的时候，我会听见倒吸气的声音。
We can all think of someone, often a young woman, who has been impacted by breast cancer.
我们常常都可以联想到某个人，经常是一位年轻女性，遭受了乳腺癌的折磨。
We often can't think of a young woman who has heart disease.
但我们却很少联想到某个年轻女性得到心脏疾病。
I'm going to tell you why. Heart disease kills people, often very quickly.
让我来告诉你们为什么。心脏疾病是会致命的，而且通常是在很短的时间内。
So the first time heart disease strikes in women and men, half of the time it's sudden cardiac death
所以当人们第一次心脏病发的时候，有一半以上的机会会立即造成心肌梗塞死亡，
no opportunity to say good-bye, no opportunity to take her to the chemotherapy, no opportunity to help her pick out a wig.
让人没有机会说再见，没有机会带她去做化疗，也没有机会帮她挑选假发。
Breast cancer, mortality is down to four percent. And that is the 40 years that women have advocated.
乳腺癌致死率降到只有4%，这是过去40年来女性不断倡导的结果。
Betty Ford, Nancy Reagan stood up and said, "I'm a breast cancer survivor," and it was okay to talk about it.
贝蒂·福特，南希·里根都公开站出来说过：“我是乳腺癌的生还者！”这不是禁忌的话题。
And then physicians have gone to bat. We've done the research.
然后医师们就开始研究讨论。我们完成了研究。
We have effective therapies now. Women are living longer than ever.
我们发明了有效的疗法。于是女性们活得比之前更久。
That has to happen in heart disease, and it's time. It's not happening, and it's time.
这些事也必须在心脏疾病的领域里发生，而且该是时候了! 是时候了，然而我们却还未这么做。
We owe an incredible debt of gratitude to these two women.
我们该将莫大的感谢送给这两位女性。
As Barbara depicted in one of her amazing movies, "Yentl," she portrayed a young woman who wanted an education.
芭芭拉，在她一部令人惊艳的电影《燕特尔》里面，诠释了一位渴望教育的年轻女性。
And she wanted to study the Talmud. And so how did she get educated then?
她想要学塔木德经。所以最后她是如何接受的教育呢？
She had to impersonate a man. She had to look like a man.
她必须要扮演成一位男性。必须要看起来就像一位男性。
She had to make other people believe that she looked like a man and she could have the same rights that the men had.
她必须要让别人相信她就像一位男性，并且她可以拥有的权利跟男性同等。
Bernadine Healy, Dr. Healy, was a cardiologist.
伯纳丁·希利博士是一位心脏病专家。
And right around that time, in the 1980's, that we saw women and heart disease deaths going up, up, up, up, up,
就在那个时候，20世纪80年代，当我们看到女性及心脏病的死亡率不断升高、升高的时候，
she wrote an editorial in the New England Journal of Medicine and said, the Yentl syndrome.
她写了一篇文章，发表在《新英格兰医学杂志》上，她说，这就是“燕特尔症状”。
Women are dying of heart disease, two, three, four times more than men.
女性死于心脏疾病的人数，要比男性多两倍、三倍、甚至四倍。
Mortality is not going down, it's going up. And she questioned, she hypothesized, is this a Yentl syndrome?
死亡率并不是在下降，而是在上升。她于是提出疑问，她做了假设，这就是“燕特尔症状”吗？
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
故事是这样的。因为女性长的不像男性，她们的心脏病不像男性模式，
that we've spent the last 50 years understanding and getting really good diagnostics and really good therapeutics,
她们没有我们研究了50年而理解的真正好的诊断和真正好的治疗，
and therefore, they're not recognized for their heart disease. And they're just passed.
所以女性的心脏疾病没有得到公认。她们就这样被忽略了。
They don't get treated, they don't get detected, they don't get the benefit of all the modern medicines.
于是她们没有得到治疗，没有被检查出来，所以现代的药物也没有给她们带来一点好处。
Doctor Healy then subsequently became the first female director of our National Institutes of Health.
之后，希利医生成为了第一位女性美国国家卫生研究院院长。
And this is the biggest biomedical enterprise research in the world. And it funds a lot of my research.
这是全世界最具权威的生物医学研究机构。它资助了我的很多研究。
It funds research all over the place. It was a very big deal for her to become director.
它在各地都有资助研究。让她成为院长，这是一个很重大的决定。
And she started, in the face of a lot of controversy, the Women's Health Initiative.
而在一片争议声中，她首先提出了妇女健康倡议（WHI）。
And every woman in the room here has benefited from that Women's Health Initiative.
在座的每一位女性都曾经受惠于WHI。
It told us about hormone replacement therapy. It's informed us about osteoporosis.
它告诉了我们荷尔蒙替代疗法，也告诉了我们骨质疏松症。
It informed us about breast cancer, colon cancer in women.
它告诉了我们关于发生在女性身上的乳腺癌、大肠癌。
So a tremendous fund of knowledge despite, again, that so many people told her not to do it, it was too expensive.
尽管这些都需要巨额的赞助，很多人告诉她不要这么做，花费太高了。
And the under-reading was women aren't worth it. She was like, "Nope. Sorry. Women are worth it."
这背后暗喻着大家觉得女性不值得这笔研究花费。但她却说：“不，不好意思，女性值得我们这么做”。
Well there was a little piece of that Women's Health Initiative that went to National Heart, Lung, and Blood Institute,
妇女健康倡议有一小部份的领域归属于美国国立心脏、肺和血液学研究所，
which is the cardiology part of the NIH.
这个研究所是国家卫生研究院的心血管部门。
And we got to do the WISE study -- and the WISE stands for Women's Ischemia Syndrome Evaluation
我们当时要进行WISE研究--WISE指的是妇女缺血综合症评估，
and I have chaired this study for the last 15 years.
过去十五年来我一直领导着这个研究。
It was a study to specifically ask, what's going on with women?
该研究的主题是女性到底怎么了？
Why are more and more women dying of ischemic heart disease?
为什么会有越来越多的女性死于缺血性心脏病？
So in the WISE, 15 years ago, we started out and said,
所以十五年前在研究WISE时，我们开始想，
"Well wow, there's a couple of key observations and we should probably follow up on that."
“哇，的确是有几个关键的发现，我们应该继续追根究底”。
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
在华盛顿特区，我们的同行们最近发表文章，把女性和男性因心脏病致死做了比较，
and again, this is millions of people, happening every day -- women, in their fatty plaque
仍有成千上万的人，每天还在发生--女性，在她们的脂肪斑块里，
and this is their coronary artery, so the main blood supply going into the heart muscle -- women erode, men explode.
这是冠状动脉，主要的血液供应进到心脏肌肉时，女性是受侵蚀式，男性是爆炸式。
You're going to find some interesting analogies in this physiology.
你们会在生理学上找到些有趣的相似。
So I'll describe the male-pattern heart attack first.
我先来描述一下男性模式的心脏病发作。
Hollywood heart attack. Ughhhh. Horrible chest pain.
好莱坞式的心脏病发作。啊。可怕的胸口痛。
EKG goes pbbrrhh, so the doctors can see this hugely abnormal EKG.
心电图一下子跳上去，所以医生看到的是巨大的异常心电图。
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.
动脉当中有一个大的血块。他们去到心导管室，嘭嘭嘭就把血块拿掉。

That's a man heart attack. Some women have those heart attacks, but a whole bunch of women have this kind of heart attack,
那是男性的心脏病发作。有些女性也是这样，但很多的妇女的心脏病发作是，
where it erodes, doesn't completely fill with clot, symptoms are subtle, EKG findings are different -- female-pattern.
动脉受到侵蚀，但没有完全被血块阻塞，症状不明显，心电图也不一样--这就是女性模式。
So what do you think happens to these gals?
这些女性会怎么样呢？
They're often not recognized, sent home. I'm not sure what it was. Might have been gas.
经常是，她们没被识别为心脏病发作，而被送回家。我不清楚是什么。可能是内部有气体。
So we picked up on that and we said,
所以我们会注意到，说，
"You know, we now have the ability to look inside human beings with these special catheters called IVUS: intravascular ultrasound."
“我们现在有能力用这些特殊的叫做IVUS的管道来透视人体内部: 血管内超声检查。”
And we said, "We're going to hypothesize that the fatty plaque in women is actually probably different, and deposited differently, than men."
我们说，“我们要假设女性体内的脂肪斑块与男性的不同，并且存积方式也不同。”
And because of the common knowledge of how women and men get fat.
根据男女如何变胖的常识。
When we watch people become obese, where do men get fat? Right here, it's just a focal -- right there.
当我们看到人发福，男性胖在哪儿呢？就在这，就一个焦点--这里。
Where do women get fat? All over. Cellulite here, cellulite here.
女性胖到哪儿呢？全身都是。这里一块赘肉，这里一团脂肪。
So we said, "Look, women look like they're pretty good about putting kind of the garbage away, smoothly putting it away.
因此我们说：“看哪，女人们很会把这些垃圾分散好，分得很顺利。
Men just have to dump it in a single area." So we said, "Let's look at these."
男人只能倒进一个地方。”我们说，“来看看这些。”
And so the yellow is the fatty plaque, and panel A is a man.
黄色是脂肪斑块，A组是男人。
And you can see, it's lumpy bumpy. He's got a beer belly in his coronary arteries.
你可以看见，这是块状沉着物，它在他的冠状动脉里面有一个很大的啤酒肚。
Panel B is the woman, very smooth. She's just laid it down nice and tidy.
B组是女性，非常平滑。她把它摆得整洁漂亮。
And if you did that angiogram, which is the red, you can see the man's disease.
而如果你做了这个血管摄影，红色的，你就会发现男性的疾病。
So 50 years of honing and crafting these angiograms, we easily recognize male-pattern disease.
所以50年来，对于这些血管摄影的琢磨，我们可以轻易的就认出男性型态的疾病。
Kind of hard to see that female-pattern disease. So that was a discovery. Now what are the implications of that?
但是女型疾病的形态却很难被确立。这是一个重大发现。那么影响会是什么呢？
Well once again, women get the angiogram and nobody can tell that they have a problem.
再一次，女性照了血管摄影，但没人能够指出她们是否有问题。
So we are working now on a non-invasive -- again, these are all invasive studies.
我们在着手于一个非侵略性的研究--事实上，这些研究都是侵略性的。
Ideally you would love to do all this non-invasively.
最理想的是，你会想用非侵入法来做这些研究。
And again, 50 years of good non-invasive stress testing, we're pretty good at recognizing male-pattern disease with stress tests.
再重复一遍，五十年来很好的非侵入的压力测试，我们已经能够很好的透过这个测试来辨识男性疾病的形态。
So this is cardiac magnetic resonance imaging. We're doing this at the Cedars-Sinai Heart Institute in the Women's Heart Center.
这是心脏病患者的核磁共振成像。我们在妇女心脏中心的雪松西奈山心脏中心做这些研究。
We selected this for the research. This is not in your community hospital, but we would hope to translate this.
我们选择这张做为研究。这虽然不是你的社区医院，我们希望能传递相同的信息。
And we're about two and a half years into a five-year study.
我们为期5年的研究已进行了一半。
This was the only modality that can see the inner lining of the heart.
这是唯一让我们可以看到心脏里层的方法。
And if you look carefully, you can see that there's a black blush right there. And that is microvascular obstruction.
如果你看得更仔细一点，会发现那里有一个黑块。那就是微血管堵塞。
The syndrome, the female-pattern now is called microvascular coronary dysfunction, or obstruction.
这个女性型态的并发症现在称为冠状动脉微血管丧失官能障碍，或堵塞。
The second reason we really liked MRI is that there's no radiation.
我们现在很喜欢核磁共振的第二个原因，是因为它没有辐射。
So unlike the CAT scans, X-rays, thalliums, for women whose breast is in the way of looking at the heart,
与计算机辅助测试扫描，X光片，铊扫描有所不同，因为女性每次做心脏测试都会考虑对乳房的影响，
every time we order something that has even a small amount of radiation, we say, "Do we really need that test?"
哪怕小数量的辐射，我们也会说：“真有做这个测试的必要吗？”
So we're very excited about M.R. You can't go and order it yet,
所以我们对于核磁共振感到很振奋。当然现在还不能说要检查就可以检查，
but this is an area of active inquiry where actually studying women is going to advance the field for women and men.
但是这是一个现在正在积极探索的领域，也是一个研究女性、却男女同时获益的领域。
What are the downstream consequences then, when female-pattern heart disease is not recognized?
当女性的心脏病没有被辨认出来的时候，对于接下来的影响会是什么呢？
This is a figure from an editorial that I published in the European Heart Journal this last summer.
这个数字来自于去年夏天我发表在《欧洲心脏期刊》里的文章。
And it was just a pictogram to sort of show why more women are dying of heart disease,
这个象形图显示，为什么还有更多的女性死于心脏病。
despite these good treatments that we know and we have work.
尽管我们知道很多的有效的治疗法。
And when the woman has male-pattern disease -- so she looks like Barbara in the movie -- they get treated.
当女性出现男性模式的病症--就像电影里的芭芭拉一样，她们才会得到医治。
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.
当你有女性模式的症状，但你看上去也是女性，就像芭芭拉和她丈夫，他们就得不到医治。
These are our life-saving treatments. And those little red boxes are deaths. So those are the consequences.
这些都是挽救生命的疗法。这些小红框子是死亡的。这些是后果。
And that is female-pattern and why we think the Yentl syndrome actually is explaining a lot of these gaps.
那个是女性模式，并且我们认为燕特尔综合症也确实解释了这些差距。
There's been wonderful news also about studying women, finally, in heart disease.
关于研究女性方面还有很多好消息，终于是跟心脏病有关的了。
And one of the the cutting-edge areas that we're just incredibly excited about is stem cell therapy.
有一个让我们异常兴奋的前沿领域，那就是干细胞疗法。
If you ask, what is the big difference between women and men physiologically?
如果你问，在生理上，女性与男性的大的不同之处在哪？
Why are there women and men? Because women bring new life into the world. That's all stem cells.
为什么会有女性和男性？因为女性把新生命带到世上。这全是干细胞。
So we hypothesized that female stem cells might be better at identifying the injury,
我们假定女性干细胞会很好地鉴别损伤，
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.
做些细胞修补或产生新的器官，这就是我们正在尝试用干细胞疗法做到的。
These are female and male stem cells. And if you had an injured organ,
这就是女性和男性干细胞。如果你的器官受损，
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?
或你心脏病发作，我们想修复受伤的地方，你想不想最先用这些强健又足够的干细胞？
Or do you want these guys, that look like they're out to lunch?
还是你会想要这些看起来懒懒散散的干细胞？
And some of our investigative teams have demonstrated that female stem cells
我们有一些调查团队已经指出，女性的干细胞
and this is in animals and increasingly we're showing this in humans -- that female stem cells,
适用于动物界，并且会慢慢衍伸到人类世界--若将女性的干细胞
when put even into a male body, do better than male stem cells going into a male body.
放进男性的身体里，它们表现得要比男性本身的干细胞还优秀。
One of the things that we say about all of this female physiology
其中一项让我们讨论女性生理学的原因，
because again, as much as we're talking about women and heart disease, women do, on average, have better longevity than men
是因为我们在谈论女性与心脏病，平均来说，女性拥有比男性更长的寿命。
is that unfolding the secrets of female physiology and understanding that is going to help men and women.
就是要揭开这些女性生理学未知的部分，并且了解这么做对不管男生或是女生同时都有益处。
So this is not a zero-sum game in anyway.
这绝对不是所谓的零和博弈。
Okay, so here's where we started. And remember, paths crossed in 1984, and more and more women were dying of cardiovascular disease.
好的，所以我们回到我们开始的地方吧。记住，两条线在1984年交会，接着越来越多的女性因为心血管疾病死亡。
What has happened in the last 15 years with this work? We are bending the curve. We're bending the curve.
过去十五年我们作了些什么？我们让曲线转向了。我们让曲线转向了。
So just like the breast cancer story, doing research, getting awareness going, it works, you just have to get it going.
就像乳腺癌的故事一样，做研究，让大家意识到这件事，这些事情是有成效的，只是还需要更加努力。
Now are we happy with this? We still have two to three more women dying for every man.
但我们现在就满意了吗？现在女性的死亡率还是男性的二到三倍。
And I would propose, with the better longevity that women have overall,
那我提议，总的来说女性比较长寿，
that women probably should theoretically do better, if we could just get treated.
如果我们女性得到医治，理论上我们的情况会更好。
So this is where we are, but we have a long row to hoe.
我们现在在这里，但我们还有很长一段路要努力。
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.
我们已经在这方面研究15年了。但如同我跟你们说过的，我们已经在男性的心脏病型态上研究了50年。
So we're 35 years behind. And we'd like to think it's not going to take 35 years.
所以我们还落后了35年。当然我们不希望要用35年的时间去追上。
And in fact, it probably won't. But we cannot stop now. Too many lives are at stake.
事实上应该也不需要。但我们不能现在就停止。有太多的生命在危急关头。
So what do we need to do? You now, hopefully, have a more personal relationship with your heart.
所以我们必须做些什么呢？希望大家跟你的心脏有个更好的个人关系。
Women have heard the call for breast cancer and they have come out for awareness campaigns.
女性已经听到了对乳腺癌的呼声，也站出来参与宣传活动。
The women are very good about getting mammograms now. And women do fundraising. Women participate.
女性对于照乳房X光片也很坦然。女性们还会筹款。她们参与其中。
They have put their money where their mouth is and they have done advocacy and they have joined campaigns.
他们把钱投入在他们提倡的事物当中，她们参加各种活动。
This is what we need to do with heart disease now.
而这正是我们现在要对心脏疾病做的事情。
And it's political. Women's health, from a federal funding standpoint, sometimes it's popular, sometimes it's not so popular.
这是政治化的。女性的健康，从国家资金的角度来看，有时候是受重视的，有时候却不然。
So we have these feast and famine cycles. So I implore you to join the Red Dress Campaign in this fundraising.
所以会有时好时坏的循环。因此我在这里恳请大家参加红衣活动，参与筹款。
Breast cancer, as we said, kills women, but heart disease kills a whole bunch more.
如同我们所说的，乳腺癌会让女性致命，但心脏疾病其实让更多的女性送命。
So if we can be as good as breast cancer and give women this new charge, we have a lot of lives to save.
所以，如果我们能做得像乳腺癌那样好，赋予女性这个责任，我们就能够因此挽救很多条生命。
So thank you for your attention.
谢谢大家的关注。