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Florencia Rolandi: The heart of a woman may break. SERIOUSLY.
What are the causes of death in males?
The leading cause of death in males
are cardiovascular diseases.
And we know that,
because women take care of our men throughout life.
And we also know why they get sick.
A few years ago and through a program of the Argentine Heart Foundation,
we conducted a survey on a representative sample
of 600 women from the metropolitan area
of Buenos Aires,
on the basis of risk factors.
And 80% of the women knew that conditions such as:
high blood pressure, high cholesterol, diabetes or smoking,
increase the risk of cardiovascular disease.
And 90% of respondents knew that chest pain
is a warning sign of a heart attack.
As well, most of them had information about
behaviors that help prevent or control
heart disease.
Then, we asked them:
“What is the leading cause of death in females?”
And, as you can see, more than half of them said that cancer is.
Particularly breast cancer.
However, what do women actually die of?
In Argentina, 1 of 3 women die of cardiovascular diseases.
More deaths than if we add up the ones from
all types of cancers, accidents and ***.
Furthermore…such data is collected by the Ministry of Health,
and shows that, since 2007,
more women than men have died of cardiovascular disease.
Today, 135 women.
And another one in the next 11 minutes.
I am a cardiologist who, since 2006,
has been committed to fighting two realities:
The first one: without doubt, cardiovascular disease
represents a major health issue for women.
The second one: and as I already told you, most women ignore that information
and have a perception that differs widely from reality.
Still…about cardiovascular disease risk factors, suc as: “diabetes, hypertension,
sedentary lifestyle, stress, overweight”… Are the same for both?
It seems so; however, this is not necessarily true.
If we talk overweight, it is not the same in women than in men.
In men, fat concentrates in the belly;
whereas in women,
it settles around the hips.
And for the heart, the fat settling around the hips
may be healthier than abdominal fat.
On the other hand, the impact risk factors have
also differs by gender.
For example: diabetes.
Diabetes is a risk factor for both men and women.
If a man has diabetes, the risk of having a heart attack is 2.6 times higher
than for the one who does not have.
However, a woman with diabetes is 4 times more likely to have
a heart attack than a woman who does not have.
And the same applies to hypertension or sedentary lifestyle,
which both increase the risks of heart attack much more in women than in men.
On the contrary, the harmful effects of smoking
are slightly worse in men than in women.
And the third point about risk factors in women is that
there may be conditions in women alone
that may increase de risk of heart disease,
that we don't know about.
And this relates to the fact that, in the past,
cardiovascular diseases were studied only in men.
And extrapolating the results from men to women
could be a mistake.
Just like studying women may bring along surprises.
Let me give you an example:
many may have heard that women of childbearing age are less likely
to suffer illnesses because of the effect of sex hormones;
a protection that we lose after menopause.
Well, for many years, women were treated
with hormone replacement therapy.
They were treated with hormone patches
as a hormone replacement therapy.
However, only research studies involving thousands of women
treated with hormone replacement therapy for many years,
demonstrated that far from protecting the heart,
it increased cardiovascular risk.
Certainly, what kills us women is replacement,
and that is a scientific evidence...
But it is a good one, because it shows that women
need to be studied in particular.
Today, the medicine is fundamentally based on clinical trials,
and even today, women remain under-represented
in research studies.
But this is something we can change.
I can show you data on heart failure,
or any of cardiovascular diseases.
The percentage of women in research studies,
treated, in this case, by heart-failure medication,
is less than 30%.
When in fact, if you measure the entire population
suffering heart failure, more than half are women.
Well…at the beginning of the talk I talked about the symptoms
and I'd like to draw your attention to this:
If the symptoms also differ
between men and women.
And I will talk about heart attack.
The most common heart attack symptom is chest pain--the squeezing one--
described over 200 years ago by a man
based on direct observation of men,
and read by men.
But there are “atypical” symptoms,
as opposed to the typical,
And those are: back pain, nausea, fatigue,
and a feeling of fullness.
A priori, we could relate “atypical” with “odd” or “unusual”.
Well, almost half of women who have a heart attack
have atypical symptoms.
And if the description of the heart attack
had been made over men and women,
the atypical would be identified as
“female”…
The fact is that the challenge entailed
in that typicality of the symptoms,
brings significant consequences.
And that is the case even when women have typical symptoms,
which can make it difficult to diagnose.
A man enters the emergency room with a heart attack,
usually saying:
“I have a chest pain, squeezing me
as If I had an elephant's foot standing in the middle of my chest."
And we all rush. The standard.
But many women describe the symptoms in a different way.
They use a description associated with feelings, such as:
“I experience some kind of anxiety, as if I needed to sigh"…
And so no rush.
Because it’s a more complex description.
And it’s crucial to be very clear when facing stroke.
Because, when the flow of blood stops,
the artery clogs abruptly
and stops feeding the heart muscle.
And for every minute of delay in opening up that artery,
the greater the potential damage to the heart.
And, clearly, higher probability of death.
Every minute counts.
And something that is usually taken as common sense,
but also demonstrated scientifically, is that
those who felt sick enough and rushed to the hospital,
are the ones who, when they started to feel sick realized that
they were having a heart attack.
And the clinical picture is facilitated by
the recognition of the early symptoms and, on the other hand,
the belief that what you are experiencing is possible happen.
And the latter is only possible if you know
you can get sick.
Let me tell you about Loli.
I met her many years ago
when she was admitted in hospital with a stroke.
Loli started feeling sick
while in a cab, very close to the hospital.
But she decided to go home instead
"so as not to worry her husband".
And because she was a teacher and had to mark exams.
Since she felt, as many women, that she had
many family responsibilities that she could not delegate.
And she thought the discomfort should go away.
Because in the end, she never imagined that what she way suffering
was having a stroke.
Loli’s case is no exception.
In Argentina, a study demonstrated that,
on average, women ask doctors
2 hours later than men.
What it means less chance of survival.
Another case.
Ana María. She was in her car, stopped
at a traffic light,
when a truck carrying frozen food,
hit the back of her car.
She gets out of the car, somewhat shocked. No serious injuries though-
heads to her car, and starts arguing with the truck driver
when she realizes the damages,
and as they were arguing, she start experiencing chest pain.
Shortly after the ambulance arrived; she is given a Philadelphia collar
and taken to the hospital where she kept describing a chest pain.
So to rule out injuries related to the accident,
she was taken X-rays and CT.
What I say is merely speculative, but
if Ana Maria had been a man taken to a hospital ER
with symptomatic effects of hyper-acute stress
for a street accident and suffering a chest pain,
it is pretty sure that she would had been referred by the doctors
to undergo an electrocardiography, to rule out a stroke
before being taken to X-ray.
Thus, having patients delaying in consulting a physician,
as well as the delays within the health system,
and the difficulty in making diagnosis
because of this atypicality,
entails that women receive less treatment for heart attack
in Argentina, but also in the rest of the world.
And an avoidable consequence is that
the fact that they receive less treatment explains in why
to some extent, more women die of a stroke than
men suffering a stroke.
Therefore, it is imperative that we,
the medical and scientific community,
step up clinical research in women
in order to provide and assure them
the best treatment and health care available.
We have another point and is related to the community,
to raise awareness.
If you, women and also you men, are convinced
that women can get heart disease,
this may have two important consequences.
The first one has to do with prevention:
and it is that women adopt healthy behaviors,
visit a doctor on a regular basis,
and be aware of their vascular risk factors.
And that men starts taking care of their women’s heart
just as women care about
our men’s hearts.
And the second outcome is that women, given the chance
they may have something, consult a doctor right away,
Because that can save their life.
Months ago, I was having an after meal conversation with friends,
and at that moment, I was working on an awareness campaign,
and very excited about the idea that
a simple campaign can save lives,
but someone told me:
"You can't expect others to dream your dream."
And I deeply hope he was wrong.
So I ask all of you to please help us,
committing yourself to spreading this message:
“The heart of a woman may break. SERIOUSLY.”
(Aplausse)