Q: Heart disease kills about 12 times more women
annually than breast cancer. Yet breast cancer gets
more research dollars and headlines. Why?
C. Noel Bairey Merz, MD: Breast cancer has had more than 40 years of successful
advocacy. We need to now do this for heart disease.
Barbra Streisand: The number of women dying from breast
cancer has significantly declined because of people
speaking out, sharing their stories, and raising
money for awareness campaigns and medical research. We
desperately need the same kind of coordinated
effort for heart disease.
Q: About 8.9 million women worldwide die of heart
disease annually. What did you think when you
first read that statistic?
Streisand: I consider myself a well-informed person,
but when I first heard that, I was stunned. Very
few people know this. And, until recently, almost no
one talked about a disease women are dying from
throughout the world.
Q: With decades of heart disease research done
primarily on men, what problems does this create
for proper treatment of women?
Bairey Merz: When I first became a cardiologist,
women were widely viewed as if they were simply
smaller versions of men. Women have paid a huge
price for the medical community not knowing about
important gender differences in heart disease.
We’ve now shown that women’s hearts are
physiologically different than men’s, and men
and women can develop a different kind of disease.
Women more frequently have major arteries clear of
plaque—unlike the classic male pattern—but their
smaller coronary blood vessels cease to constrict
and dilate properly. We call this microvascular
Streisand: We even develop plaque differently.
Bairey Merz: That’s right. Instead of the lumpy-bumpy,
fatty plaque men develop, women are more likely
to streamline it onto the wall of the artery, which is
invisible to the traditional angiogram. That’s why
we are working to develop new diagnostic tools,
so we can accurately detect small artery dysfunction.
Q: How critical is it that women educate themselves
about heart disease?
Streisand: Tragically, too many women are unaware
of the dangers of heart disease. It’s so important
to empower women to get educated.
Bairey Merz: Each woman needs to think about
her relationship with her heart. Be your own
best advocate and know the warning signs.
It’s not necessarily the classic “Hollywood
heart attack,” but can be indigestion, nausea,
or extreme fatigue.
Streisand: I learned that nearly two-thirds of women
who die from heart attacks have no history of
chest pain. Even if a woman does go to a doctor
right away, even a well-intentioned doctor,
she is often misdiagnosed.
Bairey Merz: We see women all the time who have
visited doctor after doctor for years and never
been properly diagnosed. These are experienced
cardiologists, but they haven’t been trained to
evaluate for gender-specific heart disease.
Q: Is it possible to make up for the deficit in gender-specific
Bairey Merz: We have a lot of catch-up. But we’ve
been studying women’s heart disease and
gender differences for 17 years. The good
news is that this research benefits men as well.
For example, our collaborators have discovered
that female stem cells are better at finding
injured areas of the heart after a heart attack,
which may be a better jumpstart to the regenerative process.
Streisand: I love that story. When I talk to people
around the country about heart disease, I tell
them that even male stem cells don’t like to ask for
directions. It’s a joke, but what we’re talking about
isn’t funny. We can’t afford to sit back. This is an
epidemic facing women, right now.