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MY NAME'S ELIZABETH MURPHY AND

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I'M THE HOST FOR DR. NOEL MERZ

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TALK TODAY AND THERE ARE 2

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I HAVE 2 HOUSEKEEPING ISSUES I
AM

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SUPPOSED TO DOLE WITH, 1 IS FOR

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CME CREDIT, IF YOU WANT CME

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CREDIT YOU HAVE TO TEXT THE

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NUMBER 50122 AND THE SECOND

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HOUSEKEEPING ISSUE I'M SUPPOSED

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TO DEAL WITH IS FOR THOSE OF YOU

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WHO ARE ONLINE, IF YOU HAVE

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QUESTIONS FOR THE SPEAKER PLEASE

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USE THE SEND LIVE FEEDBACK

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BUTTON ON THE VIDEOCAST PAGE.

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ALL RIGHT SO NOW THAT WE HAVE

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THE HOUSEKEEPING ISSUES DONE

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WITH, I WILL GO AHEAD AND

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INTRODUCE TODAY'S SPEAKER.

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IT'S MY TBRAIT PLEASURE TO

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INTRODUCE TODAY'S WALS LECTURE

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SPEAKER DR. NOEL MERZ, IS THE

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PROFESSOR OF CARDIOLOGY AND

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MOUNT CEDAR SINAI MEDICAL CENTER

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IN LOS ANGELES, AT CEDAR SINAI

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SHE HEADS UP THE BARBARA

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STREISANDROGEN WOMEN'S HEALTH

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CENTER AND I THINK SHE'S THE

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BARBARA STREISAND OF WOMEN'S

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MEDICAL INFORMATION.

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SHE'S CHAIR OF THE NHLBI

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SPONSORED WOMEN'S ISOTOPE KEEMIC

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SYNDROME KNOWN AS Y-STUDY AND

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THIS INVESTIGATES METHODS OF

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DIAGNOSIS AND MEDICATION FOR

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HEART DEC IN WOMEN, SHE'S

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PUBLISHED OVER 150 PAPERS AND

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CHAPTERS AND NUMEROUS AWARDS AND

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HONORS TO GIVE HER TIME TO GIVE

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HER LECTURE, I WON'T MENTION ALL

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OF THEM BUT I WILL MENTION A

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FEW, 1 IS SHE'S THE AMERICAN

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COLLEGE BERNEA DEAN HEALY

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LEADERSHIP AWARD IN WOMEN'S

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CARDIOVASCULAR DISEASE IN 2016,

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SHE ALSO RECEIVED THE RED DRESS

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AWARD FOR LEADERSHIP IN

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CARDIOVASCULAR RESEARCH IN

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WOMEN, IN ADDITION TO HER

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EXCEPTIONAL SCIENTIFIC

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ACCOMPLISHMENTS, SHE WAS ALSO

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AHEAD OF HER TIME AND A PIE O

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NEAR IN RAISING PUBLIC AWARENESS

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OF THE NEED FOR MORE STUDY IN

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WOMEN'S HEALTH ISSUES AND

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ESPECIALLY WOMEN'S

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CARDIOVASCULAR DISEASE.

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ON THE MANY THINGS SHE'S DONE TO

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GET THE MESSAGE OUT AND RAISE

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AWARENESS, SHE MODERATED A RED

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DRESS AWARENESS PANEL DISCUSSION

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AT THE RONALD REAGAN

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PRESIDENTIAL LIBRARY WITH FIRST

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LADIES LAURA BUSH AND NANCY

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REAGAN AND THIS WAS IN 2007.

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SHE ALSO HAS FREQUENT

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APPEARANCES IN THE MEDIA AND

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SHE'S APPEARED IN MANY DEFINITE

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APPEARANCES SUCH IS ON 60

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MINUTES, THE TODAY SHOW, GOOD

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MORNING AMERICA, NBC, DATELINE

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AND TWEBT 20.

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SO WE'RE IN FOR A TREAT WITH HER

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LECTURE TODAY EMPLOY SO IF YOU

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COULD JOIN ME IN WELCOMING

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DR. BAIRY MERZ, WITH A TALK

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ENTITLED NOT YOUR FATHER'S HEART

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DISEASE EMPLOY.

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THE HERSTORY AND THE NHLBI WISE.

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[ APPLAUSE ]

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>> SO THANK YOU SO MUCH

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DR. MURPHY AND YES, I AM

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DELIGHTED TO BE HERE.

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THE NATIONAL INSTITUTES OF

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HEALTH IS JUST REALLY THE MOTHER

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OF ALL OF THE BIOMEDICAL

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DISCOVERY AND NOT TO SAY THAT

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IT'S ALWAYS DONE IN THE UNITED

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STATES BUT IT'S JUST AN HONOR TO

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BE HERE AND SUCH WIDE RANGING

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IMPACT OF THIS INSTITUTE, SO,

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DR. MURPHY HAD IT RIGHT, I'M

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GOING TO TALK ABOUT NOT YOUR

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FATHER'S HEART DEC AND THIS IS

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THE HERSTORY, I DID NOT COME UP

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WITH THIS, A MALE COLLEAGUE DID

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AND THE NATIONAL HEART LUNG AND

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BLOOD SPONSORED WISE STUDY.

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THESE ARE MY DISCLOSURES OF

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COURSE, WE ALWAYS DISCLOSE

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THESE, DO NOT HAVE ANYTHING TO

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DO WITH WHAT WE'RE DOING TODAY

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BUT THOSE ARE MY DISCLOSURES.

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SO WHY WAS THE WISE THE WOMEN'S

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ISCHEMIA SIS DROAM EVALUATION

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FUNDED?

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IT WAS INITIATED BY NHLBI, I

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WILL TALK ABOUT THOSE PROGEC

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OFFICERS IN A SUBSEQUENT SLIDE

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BUT THEY WERE RESPONDING TO THIS

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SLIDE WHERE FOR THE FIRST TIME,

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EVER, IN THE 1970S, AS A

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COUNTRY, WE STARTED SEX

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STRATIFYING DISEASES AND IN

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PARTICULAR CARDIOVASCULAR

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DISEASE AND WHAT YOU CAN SEE

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HERE IS THE RED LINES ARE THE

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FEMALE CBT MORTALITY AND THESE

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WERE AJUSTED FOR AGE, ADJUSTED

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FOR ALL OF THE THINGS THAT MIGHT

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CONTRIBUTE TO THIS, SO THESE ARE

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TRUE SEX DIFFERENCES, COMPARED

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TO THE MALE LINE, CBT MORTALITY

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IN THE BLUE AND WHAT WE SEE WAS

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FOR THE FIRST TIME IN 1984,

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CARDIOVASCULAR DISEASE BECAME

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THE MAJORITY OF VICTIMS WERE

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FEMALE IN OUR COUNTRY, AND THIS

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WAS QUITE SURPRISING, THIS

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HASN'T HAPPEN INDEED RECORDED

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HISTORY, I WILL TELL YOU A BIT

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ABOUT THE YENTIL, AND THE YENTIL

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SYNDROME WHICH DR. BERNEA DEAN

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HEALY, A PRIOR DIRECTOR OF OUR

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NIH COINED IN THE NEW ENGLAND

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JOURNAL, IT TOOK ABOUT 12 YEARS

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DOES IT TOOK A WHILE FOR THE

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NATIONAL ACRONYM, AND THE

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NATIONAL HEART ASSOCIATION AS WE

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HEARD STARTED THEIR WOMEN'S

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AWARENESS CAM WARENESS--CAMPAIGF

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COURSE WAS IF IT WOULD HAVE HAD

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SOMETHING TO DO WITH ERECTILE

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DYSFUNCTION OR PROSTATE IT WOULD

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HAVE BEEN GOING SOONER BUT OF

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COURSE IT DID GET GOING.

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WE HAVE STUDIES OF FRUIT, FLIES,

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HAMSTERS, MICE, FROG, MONKEYS

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AND MEN, WITH THIS MEDICAL

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CONDITION, BUT MEDICAL RESEARCH

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OF USING WOMEN AS MEDICAL

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RESEARCH SUBRECYCLINGS NEVER

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OCCURRED TO ANYBODY AND THAT

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REALLY WAS TRUE AT THE TIME.

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SO HERE ARE 2 WISE PROJECT

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OFFICERS, THE DR. NICKENS ON THE

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LEFT DR. GEORGE SABCO ON THE

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RIGHT AND WHAT YOU CAN SEE IS

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WHAT WAS INITIATED AS A CONTRACT

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AND THESE ORIGINAL SITES WERE

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CONTRACTED SO WORKING HAND IN

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HAND WITH NATIONAL HEART LUNG

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AND BLOOD WE DESIGNED--THERE WAS

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AN IDEA ABOUT WHAT WE WERE

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SUPPOSED TO STUDY, WE WERE

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SUPPOSED TO RESPOND TO THIS

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EPIDEMIC OF DEATH IN WOMEN THAT

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WAS NOT UNDERSTOOD AT ALL AND

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WHAT YOU CAN SEE, SUBSEQUENTLY,

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IS A TREMENDOUS NUMBER OF

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ADDITIONAL NIH FUNDING AS WELL

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AS INDUSTRY PARTNERSHIPS AND I

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WILL SHOW YOU ALL THE WAY TO

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TRANSLATIONAL WHAT WE CONSIDER

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BENCH TO COMMUNITY, RANDOMIZED

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CONTROL TRIALS OF STRATEGIES TO

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AGAIN, ADDRESS THIS EPIDEMIC OF

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DEATH IN WOMEN.

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AT THE GET-GO AND REMEMBER THIS

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WAS IN THE 1980S, DIVERSITY

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EQUITY AND INCLUSION WHICH WAS

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NOT CALLED THAT THEN BUT BY

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DESIGN AND FROM INCEPTION,

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1996-THE CURRENT, THE WISE

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STUDIES OVERSAMPLED ETHNIC

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MINORITY DPROWPS, WOO DID THAT

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BY CHOOSING OUR SITES CAREFULLY,

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WOE EEEVER SAMPLED LOW SES,

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AGAIN TO BE REPRESENTATIVE TO

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THE AMERICAN PUBLIC, AND WE

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INCLUDED DETAILED QUALITY OF

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LIFE AND WHAT WE WOULD NOW CALL

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PROMs, PATIENT REPORTED

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OUTCOMES, BECAUSE BEING ALIVE

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AND BEING DEAD IS NOT ALWAYS THE

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END OF THE GAME AND SO WE'RE

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PRETTY PROUD OF THAT, OF OUR

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DIVERSITY, AND OUR

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REPRESENTATION TO AMERICAN

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WOMEN.

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SO I'M GOING TO START NOW AND

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JUST TELL YOU SORT OF HOW THIS

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STUDY PROGRESSED BECAUSE AS YOU

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CAN SEE, IT'S A PRETTY OLD STUDY

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ALTHOUGH IT KEEPS RENEWING WITH

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NEW AIMS, WE INITIALLY ADDRESSED

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A PARADOX, DEMON TRAITING THAT

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WOMEN HAVE A 2 FOLD INCREASE IN

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WHAT'S CONSIDERED AT THAT TIME

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NORMAL CORONARY ARTERIES IN THE

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SETTING OF ACUTE CORONARY

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SYNDROME, STEM NSTEMI, AND

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STEMI, OUR WORST HEART TACKS,

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ELEVATION AND MI, AND WE SIMPLY

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LOOKED AT THE DATA AVAILABLE,

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AND THESE OF COURSE WERE ALL

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DATA SETS THAT HAD CORE LABS SO

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WE DIDN'T HAVE TO GUESS ABOUT

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WHETHER OR NOT THOSE ARTERIES

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WERE OPEN OR CLOSED, WHETHER

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THEY HAD OBSTRUCTED CORONARY

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DISEASE OR NOT AND WHAT IT

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DEMONSTRATED WAS PICK A STUDY OR

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A CATEGORY OF ACUTE CORONARY

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SYNDROME ALL OF WHICH ARE

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THREATENED MIs OR MIs AND

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YOU CAN SEE THAT WOMEN HAD 2-3

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TIMES THE NUMBER OF OPEN

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CORONARY ARTERIES COMPARED TO

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THE MEN.

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NOW REMEMBER, IN THE 1980S, 90S,

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WE WERE--WE KNEW WHAT CAUSED

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HEART ATTACKS, IT WAS PLUGGED UP

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ARTERIES, RIGHT?

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AND MORE SO, TO THE POINT WHERE

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WE HAD THIS WHOLE SYSTEM OF

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BYPASS SURGERY AND TINTS AND

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DRUG ALLUDING STINTS AND DRUG

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ABSORBING STINTS AND YET IT

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DIDN'T LOOK LIKE THAT WOULD BE

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RELEVANT IN UP TO A THIRD OF

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WOMEN.

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SO THIS WAS NOT A RELATIVELY

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SMALL PROBLEM. 

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SO WITH THAT OBSERVATION AND WE

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DESIGNED THE ORIGINAL AND 102

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WISE TRIALS TO LOOK AT HERSTORY,

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NOT HISTORY, AND OUR TEAM DEFINE

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ITS AS A SYSTEMATIC APPROACH TOO

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AN IDENTIFIED PROBLEM.

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T1 IS BENCH TO BEDSIDE BUT NOTE,

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I HAVE THE ARROWS GOING BOTH

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DIRECTION, WE WILL MAKE

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OBSERVATIONS AT THE BEDSIDE, OH

254
00:10:16,545 --> 00:10:18,280
LOOK AT THAT, A WOMAN HAD A

255
00:10:18,280 --> 00:10:20,882
HEART ATTACK WITH NO OBSTRUCTIVE

256
00:10:20,882 --> 00:10:22,717
CORONARY DEC, I WONDER HOW THAT

257
00:10:22,717 --> 00:10:22,984
HAPPENED?

258
00:10:22,984 --> 00:10:24,386
SO THEN WE WILL GO BACK TO THE

259
00:10:24,386 --> 00:10:27,322
BENCH AND WORK WITH OUR BASIC

260
00:10:27,322 --> 00:10:28,156
COLLEAGUES.

261
00:10:28,156 --> 00:10:29,758
T2 OF COURSE IS BEDSIDE TO

262
00:10:29,758 --> 00:10:31,526
CLINIC SO WOE START TO DO

263
00:10:31,526 --> 00:10:34,062
RANDOMIZED CONTROL TRIALS IN

264
00:10:34,062 --> 00:10:35,630
HUMANS THAT HAVE THE CONDITION

265
00:10:35,630 --> 00:10:38,833
AND THEN T3 IS THAT WE DO

266
00:10:38,833 --> 00:10:39,668
STRATEGY TRIALS, WE DEMON TRAIT

267
00:10:39,668 --> 00:10:43,271
THAT IT DOES OR DOES NOT WORK IN

268
00:10:43,271 --> 00:10:44,539
A REAL WORLD SITUATION AND AGAIN

269
00:10:44,539 --> 00:10:47,275
WE CAN MAKE OBSERVATIONS AT THE

270
00:10:47,275 --> 00:10:49,811
COMMUNITY AND GO BACK AND REFINE

271
00:10:49,811 --> 00:10:50,879
SOME'VE OUR CLINICAL TRIALS TO

272
00:10:50,879 --> 00:10:54,749
MAKE THEM MORE ADAPTABLE.

273
00:10:54,749 --> 00:10:57,052
SO 4 STEPS, OBSERVATION,

274
00:10:57,052 --> 00:10:58,119
MECHANISMS, INTERVENTION AND

275
00:10:58,119 --> 00:11:04,526
TRANSLATION, SO LET'S GO FORWARD

276
00:11:04,526 --> 00:11:05,393
WITH FURTHER OBSERVATION.

277
00:11:05,393 --> 00:11:06,995
SO WE WERE CURIOUS ABOUT THIS

278
00:11:06,995 --> 00:11:09,197
PARADOX, HOW COULD WOMEN HAVE

279
00:11:09,197 --> 00:11:12,100
HEART ATTACKS AND ACUTE CORONARY

280
00:11:12,100 --> 00:11:13,068
SYNDROMES WITH NO CORONARY

281
00:11:13,068 --> 00:11:14,803
DISEASE, I HAD THE GREAT BENEFIT

282
00:11:14,803 --> 00:11:16,304
OF WORKING WITH DR. KARL

283
00:11:16,304 --> 00:11:17,706
[INDISCERNIBLE] AND HE'S

284
00:11:17,706 --> 00:11:19,674
REMAINED A CO-PI WITH ME

285
00:11:19,674 --> 00:11:20,942
THROUGHOUT.

286
00:11:20,942 --> 00:11:21,977
WE DESCRIBED A PHENOTYPE WHERE

287
00:11:21,977 --> 00:11:28,717
YOU CAN SEE THE PATIENT IN PANEL

288
00:11:28,717 --> 00:11:32,621
A HAS EXTERNAL AGINA WHERE THE

289
00:11:32,621 --> 00:11:34,990
PHYSICIAN ORDERED A MYOCARDIAL

290
00:11:34,990 --> 00:11:36,858
SPECT, THAT IS I LITTLE HEART

291
00:11:36,858 --> 00:11:37,892
AND A CARDIOLOGIST WOULD TELL

292
00:11:37,892 --> 00:11:41,329
YOU THAT IS WHERE THE ABNORMAL

293
00:11:41,329 --> 00:11:43,965
BLOOD FLOW TO THE HEART IS AND

294
00:11:43,965 --> 00:11:46,668
THAT'S WHAT'S CAUSING THE AN

295
00:11:46,668 --> 00:11:48,637
GUINA AND THEREFORE BECAUSE IT'S

296
00:11:48,637 --> 00:11:51,640
IN THE LEFT CORONARY DESCENDING

297
00:11:51,640 --> 00:11:53,608
ARTERY, LET'S DO AN ANGIO GRAM

298
00:11:53,608 --> 00:11:55,477
AND OPEN UP THE ARTERY BUT IT

299
00:11:55,477 --> 00:11:58,079
TURNS OUT THE ARTERY IS OPEN,

300
00:11:58,079 --> 00:12:01,383
WIDE OPEN.

301
00:12:01,383 --> 00:12:03,785
DR. KARL PEPINE WAS A CORONARY

302
00:12:03,785 --> 00:12:04,686
PHYSIOLOGIST, HAD GROWN UP AT

303
00:12:04,686 --> 00:12:07,188
THE TIME WHERE MEASURING FLOW

304
00:12:07,188 --> 00:12:09,491
AND UNDERSTANDING FLOW IN THE

305
00:12:09,491 --> 00:12:11,493
ABSENCE OF OBLIGATIONS YECTIVE

306
00:12:11,493 --> 00:12:14,596
CORONARY DEC WAS IMPORTANT AND

307
00:12:14,596 --> 00:12:16,464
RELEVANT AND DR. PEPINE SAID

308
00:12:16,464 --> 00:12:17,565
LET'S PUT DOWN WIRES.

309
00:12:17,565 --> 00:12:20,168
WE USED TO BE ABLE DO THIS

310
00:12:20,168 --> 00:12:21,670
BEFORE WE BECAME ANATOMISTS AND

311
00:12:21,670 --> 00:12:23,204
WHAT LOW AND BEHOLD, AS WE DID

312
00:12:23,204 --> 00:12:25,640
MORE AND MORE OF THIS, THESE

313
00:12:25,640 --> 00:12:29,511
PATIENTS HAD AN ABNORMAL FLOW

314
00:12:29,511 --> 00:12:29,844
RESERVE.

315
00:12:29,844 --> 00:12:31,112
THEIR EPICARDIAL LARGE ARTERIES

316
00:12:31,112 --> 00:12:32,747
WERE OPEN SO IT IS A SMALL

317
00:12:32,747 --> 00:12:34,282
VESSEL PROBLEM AND THESE ARE THE

318
00:12:34,282 --> 00:12:36,117
SMALL VESSELS YOU CAN'T SEE, YOU

319
00:12:36,117 --> 00:12:37,052
CAN MEASURE FLOW BUT YOU

320
00:12:37,052 --> 00:12:38,119
COOPERATE SEE THEM WITH THE

321
00:12:38,119 --> 00:12:42,257
EXCEPTION OF SOME ADVANCED

322
00:12:42,257 --> 00:12:42,657
IMAGING.

323
00:12:42,657 --> 00:12:44,592
WE ALSO DID, WHICH WAS HIGHLY

324
00:12:44,592 --> 00:12:48,330
NOVEL AT THE TIME INTRA VASCULAR

325
00:12:48,330 --> 00:12:50,065
CORONARY ULTRASOUND, LITTLE TINY

326
00:12:50,065 --> 00:12:52,934
ULTRASOUND PROBES GOING DOWN

327
00:12:52,934 --> 00:12:54,669
INTO HUMAN CORONARY ARTERIES AND

328
00:12:54,669 --> 00:12:57,572
WHAT WE DEMON TRAITED WAS

329
00:12:57,572 --> 00:12:59,007
DIFFUSED ABNORMAL GLUCOSE

330
00:12:59,007 --> 00:13:02,777
TOLERANCELER O SCLEROSIS DESPITE

331
00:13:02,777 --> 00:13:04,512
ARTERIES AGAIN TYPICALLY IN

332
00:13:04,512 --> 00:13:06,414
WOMEN, WITH A HEALTH ECONOMIST

333
00:13:06,414 --> 00:13:09,718
AND LARGE DATA SET, NCDR, WE

334
00:13:09,718 --> 00:13:10,352
ESTIMATED 3 MILLION PEOPLE IN

335
00:13:10,352 --> 00:13:13,488
THE U.S. HAD THIS, A MUCH LARGER

336
00:13:13,488 --> 00:13:14,322
PROBLEM THAN BREAST CANCER AND

337
00:13:14,322 --> 00:13:16,758
IT WAS A LETHAL PROBLEM AND IT'S

338
00:13:16,758 --> 00:13:20,195
NOW CALLED ISCHEMIA WITH NO

339
00:13:20,195 --> 00:13:21,029
OBSTRUCTIVE CORONARY DEC, SO FOR

340
00:13:21,029 --> 00:13:23,164
THOSE WHAT ARE IN THE CORONARY

341
00:13:23,164 --> 00:13:24,866
AREA, OR GENERAL MEDICINE FOR

342
00:13:24,866 --> 00:13:28,403
AREA, THIS IS NOW ACRONYMS AND

343
00:13:28,403 --> 00:13:31,840
BILLING CODES FOR INOKA AT THIS

344
00:13:31,840 --> 00:13:32,040
TIME.

345
00:13:32,040 --> 00:13:35,577
WORKING WITH ANOTHER COLLEAGUE,

346
00:13:35,577 --> 00:13:36,544
DR. MARTHA GILOTTI, WHO AT THE

347
00:13:36,544 --> 00:13:38,079
TIME WAS AT CHICAGO IN

348
00:13:38,079 --> 00:13:39,414
NORTHWESTERN, WE NEEDED A REFOR

349
00:13:39,414 --> 00:13:40,181
INSTANCE CONTROL GROUP.

350
00:13:40,181 --> 00:13:42,150
WE HAD WOMEN THAT WE HAD

351
00:13:42,150 --> 00:13:46,388
FOLLOWED NOW FOR 5-7 YEARS AND

352
00:13:46,388 --> 00:13:48,156
WE HAD ASKED ACTUALLY NHLBI IF

353
00:13:48,156 --> 00:13:49,224
WE COULD INCLUDE MEN AS A

354
00:13:49,224 --> 00:13:54,729
CONTROL GROUP AND THEY SAID NO.

355
00:13:54,729 --> 00:13:56,264
SO WE FOUND A CONTROL GROUP

356
00:13:56,264 --> 00:13:58,666
WORKING WITH DR. MARTHA GILOTTI,

357
00:13:58,666 --> 00:14:03,838
WHO HAD REFERENCE TO A LARGE

358
00:14:03,838 --> 00:14:04,739
CHICAGO ASYMPTOMATIC WOMEN PAIK

359
00:14:04,739 --> 00:14:06,174
HEART STUDY WHERE THESE WOMEN

360
00:14:06,174 --> 00:14:08,610
WERE ALL STUDIED INCLUDING

361
00:14:08,610 --> 00:14:09,511
EXERCISE TREADMILL TESTING WHICH

362
00:14:09,511 --> 00:14:13,815
WAS NEGATIVE AND WHAT WE DEMON

363
00:14:13,815 --> 00:14:19,621
TRAITED WAS THESE WOMEN HAD 12

364
00:14:19,621 --> 00:14:25,660
TIMES HIGHER, 12% 5 YEAR

365
00:14:25,660 --> 00:14:27,662
COMBINED MACE RATE, MI,

366
00:14:27,662 --> 00:14:29,597
CARDIOVASCULAR, DEATH, THIS WAS

367
00:14:29,597 --> 00:14:30,899
NOT A BENIGN PROGNOSIS WHICH ALL

368
00:14:30,899 --> 00:14:33,034
OF THE PREVIOUS STUDIES HAD

369
00:14:33,034 --> 00:14:34,102
FOLLOWED LESS THAN A HUNDRED

370
00:14:34,102 --> 00:14:36,171
WOMEN AND THEY HAD FOLLOWED THEM

371
00:14:36,171 --> 00:14:38,573
FOR LESS THAN 3 YEARS.

372
00:14:38,573 --> 00:14:41,309
SO THIS WAS A BIT EYE OPENING.

373
00:14:41,309 --> 00:14:43,144
NOW WE'VE MADE SOME OTHER

374
00:14:43,144 --> 00:14:44,546
OBSERVATIONS, I'M GOING TO JUST

375
00:14:44,546 --> 00:14:49,684
SORT OF SPIN THROUGH THESE.

376
00:14:49,684 --> 00:14:50,718
WORKING WITH DR. VERMONI, WHO

377
00:14:50,718 --> 00:14:52,287
WAS AT THE UNIFORMED HEALTH

378
00:14:52,287 --> 00:14:54,222
SERVICES HOSPITAL AND SHE HAD A

379
00:14:54,222 --> 00:14:57,058
FREEZER FULL OF SUDDEN CARDIAC

380
00:14:57,058 --> 00:15:00,628
DEATH VICTIMS WHO HAD ALL ALL

381
00:15:00,628 --> 00:15:03,565
ABOUT NECROPSYSED TO SEE IF THEY

382
00:15:03,565 --> 00:15:07,235
HAD HEART ATTACK OR SOME OTHER

383
00:15:07,235 --> 00:15:07,902
PROBLEM.

384
00:15:07,902 --> 00:15:09,270
BASICALLY IN COMPARING WOMEN ON

385
00:15:09,270 --> 00:15:11,539
THE TOP, THIS CROSS SECTIONAL OF

386
00:15:11,539 --> 00:15:13,608
THE CORONARY ARTERY COMPARED TO

387
00:15:13,608 --> 00:15:17,078
MEN, BOTH HAD HAD HEART ATTACKS,

388
00:15:17,078 --> 00:15:18,813
BOTH HAD SUDDEN DEATH, IT WAS

389
00:15:18,813 --> 00:15:20,248
CLEAR THAT WOMEN WERE ERODING

390
00:15:20,248 --> 00:15:23,852
THE FIBROUS CAP OF THE PLAQUE

391
00:15:23,852 --> 00:15:27,522
WHERE MEN WERE EXPLODING AND THE

392
00:15:27,522 --> 00:15:29,123
EROSION WILL CALLS MICROTHROMBI

393
00:15:29,123 --> 00:15:32,794
AND WE WERE SUBSEQUENTLY ABLE TO

394
00:15:32,794 --> 00:15:35,096
DEMONSTRATE SMALL, SMALL

395
00:15:35,096 --> 00:15:36,064
NONSEGMENTAL INFARCs IN THESE

396
00:15:36,064 --> 00:15:37,799
WOMEN COMPARED TO MEN WHO WOULD

397
00:15:37,799 --> 00:15:40,902
HAVE A VERY LARGE THROMBUS, THEY

398
00:15:40,902 --> 00:15:42,604
WOULD INCLUDE THE ARTERY AND I

399
00:15:42,604 --> 00:15:45,907
HAVE MUCH MORE DEFINITIVE HEART

400
00:15:45,907 --> 00:15:46,841
ATTACK, THESE SYMPTOMS OFTEN

401
00:15:46,841 --> 00:15:49,744
WOULD COME AND GO, MIGHT BE

402
00:15:49,744 --> 00:15:50,311
CALLED ATYPICAL, WHERE THIS

403
00:15:50,311 --> 00:15:52,814
WOULD BE THE CLASSIC HOLLYWOOD

404
00:15:52,814 --> 00:15:55,416
HEART ATTACK, AND THESE WERE

405
00:15:55,416 --> 00:15:56,351
IMPORTANT DIFFERENCES, NOT ONLY

406
00:15:56,351 --> 00:15:57,852
IN THE PLAQUE AND COMPOSITION

407
00:15:57,852 --> 00:15:58,987
BUT THEY CONTRIBUTED TO THIS

408
00:15:58,987 --> 00:16:02,423
UNDERSTANDING THAT WOMEN HAD

409
00:16:02,423 --> 00:16:03,491
MORE QUOTE-ATYPICAL SYMPTOMS,

410
00:16:03,491 --> 00:16:05,760
WHAT WE NOW RECOGNIZE IS THAT

411
00:16:05,760 --> 00:16:07,762
WOMEN JUST HAVE DIFFERENT

412
00:16:07,762 --> 00:16:08,096
SYMPTOMS.

413
00:16:08,096 --> 00:16:09,764
THEY'RE NOT ATYPICAL, IN THE

414
00:16:09,764 --> 00:16:11,633
INITANCE 51% OF THE POPULATION

415
00:16:11,633 --> 00:16:15,436
IS FEMALE, WE MIGHT SAY THEY'RE

416
00:16:15,436 --> 00:16:17,171
THE CLASSIC SYMPTOMS, SO WE ALSO

417
00:16:17,171 --> 00:16:20,174
DID THIS INTRA VASCULAR CORONARY

418
00:16:20,174 --> 00:16:21,609
ULTRA SOUND CALLED IBIS, IT WAS

419
00:16:21,609 --> 00:16:23,378
NEW AT THE TIME AND WHAT WE WERE

420
00:16:23,378 --> 00:16:25,013
ABLE TO DEMONSTRATE AND THIS IS

421
00:16:25,013 --> 00:16:29,183
A  CARTOON THAT CAPITULATES WHAT

422
00:16:29,183 --> 00:16:30,852
WE FOUND WITH THE CLEVELAND

423
00:16:30,852 --> 00:16:33,054
CLINIC BECAUSE AGAIN TO GET

424
00:16:33,054 --> 00:16:35,423
CONTROL MALE PATTERN WE HAD TO

425
00:16:35,423 --> 00:16:36,224
COLLABORATE WITH PEOPLE, SO

426
00:16:36,224 --> 00:16:42,096
PANEL A IS A REP --REPRESENTATIE

427
00:16:42,096 --> 00:16:44,165
MALE, AND THE LUMENNOGRAM WHEN

428
00:16:44,165 --> 00:16:45,934
WE DO ANGIO APPLYINGS DEPICTED

429
00:16:45,934 --> 00:16:47,335
BY THE RED, THE PRESSURE MEANING

430
00:16:47,335 --> 00:16:48,970
THE FLOW HERE IS DEPICTED IN

431
00:16:48,970 --> 00:16:52,206
THIS LINE AND THE PLAQUE IS THE

432
00:16:52,206 --> 00:16:52,440
YELLOW.

433
00:16:52,440 --> 00:17:01,015
THE YELLOW ABNORMAL --ABNORMAL E

434
00:17:01,015 --> 00:17:02,984
TOLERANCELER O SCLERRIC ATTACK,

435
00:17:02,984 --> 00:17:05,053
WHERE WOULD YOU BYPASS?

436
00:17:05,053 --> 00:17:06,321
WHERE WOULD YOU STINT?

437
00:17:06,321 --> 00:17:08,690
THAT'S THE SORT OF CLASSIC MALE

438
00:17:08,690 --> 00:17:12,293
PATTERN TIMES WE CALL IT LUMPY

439
00:17:12,293 --> 00:17:15,163
BUMPY, OR SIMILAR TO HOW MANY

440
00:17:15,163 --> 00:17:16,798
WHEN THEY BECOME OVERWEIGHT OR

441
00:17:16,798 --> 00:17:18,399
OBESE, THEY TYPICALLY PUT IT IN

442
00:17:18,399 --> 00:17:21,135
1 SPOT IN THEIR VISCERA,

443
00:17:21,135 --> 00:17:23,638
SOMETIMES CALLED THE BEER BELLY.

444
00:17:23,638 --> 00:17:25,006
THE REPRESENTATIVE WOMAN AT THIS

445
00:17:25,006 --> 00:17:26,541
POINT, SHE DIDN'T REALLY HAVE

446
00:17:26,541 --> 00:17:27,809
ANY OBSTRUCTION, DID SHE BUT

447
00:17:27,809 --> 00:17:29,477
SHE'S GOT PLENTY OF PLAQUE.

448
00:17:29,477 --> 00:17:32,880
SHE HAS REMODELED HER ARTERY, TO

449
00:17:32,880 --> 00:17:35,650
BE THE LUMEN OFTEN WILL BE

450
00:17:35,650 --> 00:17:38,086
SMOOTH, SO A DIAGNOSTIC

451
00:17:38,086 --> 00:17:39,354
LUMENNOGRAM, ANKIO GRAPH WILL

452
00:17:39,354 --> 00:17:41,322
NOT SHOW YOU THAT AND YET HER

453
00:17:41,322 --> 00:17:44,659
FLOW IS JUST AS BAD AS HIS FLOW

454
00:17:44,659 --> 00:17:46,995
AT THE END OF THE ARTERY SO

455
00:17:46,995 --> 00:17:48,496
MYOCARDIUM IS NOT GETTING

456
00:17:48,496 --> 00:17:52,400
THEOXIEN IT NEEDS AND AGAIN, WE

457
00:17:52,400 --> 00:17:54,135
NEED--ANALOGIZE THIS TO HOW DO

458
00:17:54,135 --> 00:17:55,536
WOMAN WHEN THEY BECOME

459
00:17:55,536 --> 00:17:56,437
OVERWEIGHT AND OBESE.

460
00:17:56,437 --> 00:17:58,406
WELL IT'S THAT LOVELY CELLUE

461
00:17:58,406 --> 00:18:01,909
LIE, IT'S NOT VISCERAL, IT'S

462
00:18:01,909 --> 00:18:03,544
SMOOTH, AND MAYBE LESS HARMFUL,

463
00:18:03,544 --> 00:18:05,146
WE DON'T KNOW ABOUT THE

464
00:18:05,146 --> 00:18:06,814
DIFFERENCES IN PLAQUE HERE, BUT

465
00:18:06,814 --> 00:18:08,583
IT WAS VERY CLEAR THAT WOMEN AND

466
00:18:08,583 --> 00:18:10,551
MEN WERE LAYING DOWN THEIR

467
00:18:10,551 --> 00:18:13,321
PLAQUE DIFFERENTLY IN RESPONSE

468
00:18:13,321 --> 00:18:14,689
TO CORONONARY ABNORMAL GLUCOSE

469
00:18:14,689 --> 00:18:15,623
TOLERANCELER O SCLEROSIS, SO

470
00:18:15,623 --> 00:18:20,028
WITH THOSE OBSERVATIONS OF THESE

471
00:18:20,028 --> 00:18:22,597
IMPORTANT PHENOTYPES THAT WERE

472
00:18:22,597 --> 00:18:23,197
CHARACTERIZING ISOTOPE KEEMIC

473
00:18:23,197 --> 00:18:25,199
HEART DEC IN WOMEN, WE MOVED ON

474
00:18:25,199 --> 00:18:26,634
TO UNDERSTANDING MECHANISMS, AND

475
00:18:26,634 --> 00:18:29,671
WORKING WITH MY PARTNER IN CRIME

476
00:18:29,671 --> 00:18:31,105
DR. LESRY SHAH, SHE'S A HEALTH

477
00:18:31,105 --> 00:18:33,007
OUTCOMES EXPERT AND AN ECONOMIC

478
00:18:33,007 --> 00:18:35,276
ANALYSIS, WE SAID, OKAY, WHAT

479
00:18:35,276 --> 00:18:38,479
WOULD BE SORT OF SOME TESTABLE

480
00:18:38,479 --> 00:18:40,682
MECHANISTIC HYPOTHESIS, AND WE

481
00:18:40,682 --> 00:18:42,050
DEVELOPED THIS HYPOTHE--THISICAL

482
00:18:42,050 --> 00:18:43,351
NEW UNDERSTANDING OF ISOTOPE

483
00:18:43,351 --> 00:18:44,619
KEEMIC HEART DEC IN WOMEN.

484
00:18:44,619 --> 00:18:48,656
WE OF COURSE, WERE INTERESTED IN

485
00:18:48,656 --> 00:18:50,925
A SEQUENCE AND WE HAVE FOLLOWED

486
00:18:50,925 --> 00:18:53,261
SOME OF THESE WOMEN NOW FOR OVER

487
00:18:53,261 --> 00:18:53,961
20 YEARS.

488
00:18:53,961 --> 00:18:56,631
THE END GAME, RIGHT, IS

489
00:18:56,631 --> 00:18:58,800
OBSTRUCTIVE CORONARY DISEASE,

490
00:18:58,800 --> 00:19:00,635
AND WE HYPOTHESIZED THAT BY THE

491
00:19:00,635 --> 00:19:03,171
TIME WOMEN DEVELOP THEIR

492
00:19:03,171 --> 00:19:04,172
SUBCLINICAL ABNORMAL GLUCOSE

493
00:19:04,172 --> 00:19:05,440
TOLERANCELER O SCLEROSIS THAT

494
00:19:05,440 --> 00:19:06,974
THEY HAVE TRANSITIONED FROM A

495
00:19:06,974 --> 00:19:09,077
NORMAL ARTERY AND A NORMAL

496
00:19:09,077 --> 00:19:11,379
CORONARY FLOW RESERVE, THAT'S

497
00:19:11,379 --> 00:19:13,948
WHAT CFR STANDS FOR TO BEGINNING

498
00:19:13,948 --> 00:19:16,784
OF AN ABNORMAL FLOW RESERVE.

499
00:19:16,784 --> 00:19:19,220
AND FOR REASONS POTENTIALLY

500
00:19:19,220 --> 00:19:21,856
RELATED TO DIFFERENCES IN

501
00:19:21,856 --> 00:19:23,891
HORMONES, DIFFERENCES IN FAT

502
00:19:23,891 --> 00:19:24,792
DEPOSITION, HYPERTENSION AND

503
00:19:24,792 --> 00:19:25,226
LIPIDS.

504
00:19:25,226 --> 00:19:27,462
WE KNOW THAT WOMEN ARE MUCH MORE

505
00:19:27,462 --> 00:19:29,097
LIKELY TO HAVE AUTOIMMUNE

506
00:19:29,097 --> 00:19:30,465
DISEASES THAT MAY BE

507
00:19:30,465 --> 00:19:32,233
CONTRIBUTING, THERE ARE LINKS TO

508
00:19:32,233 --> 00:19:33,267
CARDIOVASCULAR DISEASE, AND WE

509
00:19:33,267 --> 00:19:37,271
KNOW THAT WOMEN MORE LIKELY HAVE

510
00:19:37,271 --> 00:19:39,440
ABNORMAL FUNCTION, WOMEN HAVE

511
00:19:39,440 --> 00:19:41,676
MORE MIGRAINES WOMEN HAVE MORE

512
00:19:41,676 --> 00:19:44,412
RENODES, SO THERE WERE MANY

513
00:19:44,412 --> 00:19:45,980
MECHANISTIC PATHWAYS THAT WE

514
00:19:45,980 --> 00:19:48,282
PROPOSE THAT MIGHT

515
00:19:48,282 --> 00:19:49,183
PREVENTIVEIENTERALLY HAVE WOMEN

516
00:19:49,183 --> 00:19:51,152
PRESENT WITH ISOTOPE KEEMIC

517
00:19:51,152 --> 00:19:53,121
HEART DEC AS ABNORMAL SMALL

518
00:19:53,121 --> 00:19:54,522
VESSEL DYSFUNCTION AS OPPOSE TO

519
00:19:54,522 --> 00:19:56,624
WAITING UNTIL THEY BECOME

520
00:19:56,624 --> 00:19:57,358
OBSTRUCTIVE PLAQUE.

521
00:19:57,358 --> 00:19:59,827
SO WE'VE GONE FORWARD TESTING

522
00:19:59,827 --> 00:20:02,196
THESE MECHANISMS, WE AGAIN

523
00:20:02,196 --> 00:20:04,499
BROUGHT BACK WITH DR. PEPINE'S

524
00:20:04,499 --> 00:20:06,667
HELP AND GOT YOUNG INVESTIGATORS

525
00:20:06,667 --> 00:20:09,570
TO BE TESTING CORONARY FUNCTION

526
00:20:09,570 --> 00:20:11,305
IN OUR CATH LABS, THIS IS

527
00:20:11,305 --> 00:20:13,775
INVASIVE AND REQUIRES AN

528
00:20:13,775 --> 00:20:15,309
INTERVENTIONAL CARDIOLOGIST, IT

529
00:20:15,309 --> 00:20:19,313
IS A PCI OR PTCA SET UP AND THEN

530
00:20:19,313 --> 00:20:21,382
WE BROUGHT IN THESE DOPPLER FLOW

531
00:20:21,382 --> 00:20:26,020
PROBES THAT HAD BEEN SITTING IN

532
00:20:26,020 --> 00:20:29,323
CLOSETS AND YOU KNOW THE

533
00:20:29,323 --> 00:20:30,258
INTERVENTIONAL CARDIOLOGISTS ALL

534
00:20:30,258 --> 00:20:34,061
THOUGHT WE WERE CRAZY BUT WE

535
00:20:34,061 --> 00:20:34,796
DEVELOPED A SEQUENTIAL

536
00:20:34,796 --> 00:20:35,930
INTERCORONARY TESTING WHERE WE

537
00:20:35,930 --> 00:20:41,102
CAN TEST FOR PATHWAYS, THE

538
00:20:41,102 --> 00:20:41,669
CORONARY MICROVASCULATURE

539
00:20:41,669 --> 00:20:42,804
AUTOREGULATES ITSELF LIKE YOUR

540
00:20:42,804 --> 00:20:46,574
COMPUTER IN YOUR CAR NOW, AND SO

541
00:20:46,574 --> 00:20:48,543
WE COULD TEST EACH OF THESE

542
00:20:48,543 --> 00:20:50,778
PATHWAYS AND PEOPLE WILL BE MORE

543
00:20:50,778 --> 00:20:51,512
OR LESS DYSFUNCTIONAL DEPENDING

544
00:20:51,512 --> 00:20:53,748
ON HOW MANY OF THESE PATHWAYS

545
00:20:53,748 --> 00:20:54,882
ARE FUNCTIONING ABNORMALITIES

546
00:20:54,882 --> 00:20:55,216
NORMALLY.

547
00:20:55,216 --> 00:20:57,652
WITH THESE LONG-TERM FOLLOW UPS,

548
00:20:57,652 --> 00:20:58,920
AS I'VE DESCRIBED, WE'VE BEEN

549
00:20:58,920 --> 00:21:01,522
ABLE TO DEMON TRAIT, THAT WOMEN

550
00:21:01,522 --> 00:21:06,127
MOST OFTEN, 2/3RDS OF THE TIME,

551
00:21:06,127 --> 00:21:07,395
HAVE NONOBSTRUCTIVE ABNORMAL

552
00:21:07,395 --> 00:21:09,797
GLUCOSE TOLERANCELER O SCLEROTIC

553
00:21:09,797 --> 00:21:12,533
PLAQUE, THEY ALMOST ALWAYS HAVE

554
00:21:12,533 --> 00:21:13,267
ENDOTHELIAL DYSFUNCTION, WE

555
00:21:13,267 --> 00:21:15,169
DEMONSTRATE THAD THE IMPAIRED

556
00:21:15,169 --> 00:21:17,538
VESSEL DILATION, THIS IS THE

557
00:21:17,538 --> 00:21:24,011
MOST SERIOUS ADVERSE BECAUSE IT

558
00:21:24,011 --> 00:21:27,014
PREDICTS, THE MACE AS WELL AS

559
00:21:27,014 --> 00:21:28,516
ALL CAUSAL MORTALITY.

560
00:21:28,516 --> 00:21:30,785
THE RESTRICTION CAUSES A LOT OF

561
00:21:30,785 --> 00:21:32,653
AN GUINA THAT RESULTS IN COST

562
00:21:32,653 --> 00:21:33,988
UTILIZATION AS WELL AS MORBIDITY

563
00:21:33,988 --> 00:21:35,857
AND THIS IS WORKING WITH YOUNG

564
00:21:35,857 --> 00:21:36,924
INVESTIGATORS, FELLOWS AND POST

565
00:21:36,924 --> 00:21:41,662
DOCS WHO THEN GO ON, TO THEIR

566
00:21:41,662 --> 00:21:43,331
OWN CAREERS, SO MOVING FROM

567
00:21:43,331 --> 00:21:46,500
MECHANISMS, THEN OF COURSE, WE

568
00:21:46,500 --> 00:21:51,305
NOW CAN TEST INTERVENTIONS IF WE

569
00:21:51,305 --> 00:21:52,240
REPURPOSE DRUGS OR DEVICES THAT

570
00:21:52,240 --> 00:21:54,308
WE ALREADY KNOW WORKS FOR SOME

571
00:21:54,308 --> 00:21:56,043
COMPONENT OF THAT MECHANISM OR

572
00:21:56,043 --> 00:22:05,620
EVEN A NEW DRUGS, SO WE OF

573
00:22:05,620 --> 00:22:07,321
COURSE WANTED TO UNDERSTAND AND

574
00:22:07,321 --> 00:22:09,190
THIS SLIDE DEMONSTRATES HOW WE

575
00:22:09,190 --> 00:22:09,490
GOT STARTED.

576
00:22:09,490 --> 00:22:14,562
THE GAL ON THE RIGHT IS BARBARA

577
00:22:14,562 --> 00:22:16,097
STREISAND AND SHE IS DRESSED UP

578
00:22:16,097 --> 00:22:19,267
LIKE A MAN, AND THOSE OF YOU

579
00:22:19,267 --> 00:22:22,303
REMEMBER THE MOVIE IN 1991

580
00:22:22,303 --> 00:22:23,404
YENTEL, SHE PORTRAYS A YOUNG

581
00:22:23,404 --> 00:22:25,573
WOMEN WHO TURN OF THE CENTURY

582
00:22:25,573 --> 00:22:27,842
EASTERN EUROPE WANTS TO BE

583
00:22:27,842 --> 00:22:29,043
LITERATE, SHE WANTS TO LEARN HOW

584
00:22:29,043 --> 00:22:32,480
TO READ AND WRITE AND AT THAT

585
00:22:32,480 --> 00:22:34,081
TIME THE ONLY PEOPLE WHO COULD

586
00:22:34,081 --> 00:22:36,484
LEARN THAT WERE MEN.

587
00:22:36,484 --> 00:22:39,287
SO SHE DRESSES UP AS A MAN.

588
00:22:39,287 --> 00:22:41,689
DR. HEALY OUR PRIOR BUT NOW

589
00:22:41,689 --> 00:22:43,958
PASSED UNFORTUNATELY NIH

590
00:22:43,958 --> 00:22:46,928
DIRECTOR AND A CLINICAL

591
00:22:46,928 --> 00:22:47,495
INVESTIGATIVE CARDIOLOGIST

592
00:22:47,495 --> 00:22:49,163
HERSELF OPINED IN THE NEW

593
00:22:49,163 --> 00:22:50,965
ENGLAND JOURNAL, I THINK THE

594
00:22:50,965 --> 00:22:52,833
REASON WE'RE MISSING THESE

595
00:22:52,833 --> 00:22:54,101
WOMEN, WHY WE'RE SEEING THIS

596
00:22:54,101 --> 00:22:55,269
INCREASE IN DEATH AND BECAUSE

597
00:22:55,269 --> 00:22:56,804
THEY DON'T LOOK LIKE MEN.

598
00:22:56,804 --> 00:23:00,408
AND SO AGAIN, WE STARTED WORKING

599
00:23:00,408 --> 00:23:03,744
TO NOW TRANSLATE THESE FINDINGS

600
00:23:03,744 --> 00:23:07,214
INTO SOMETHING THAT WOULD BE

601
00:23:07,214 --> 00:23:07,815
RELEVANT.

602
00:23:07,815 --> 00:23:10,151
THIS IS AN OPED THAT WE WROTE IN

603
00:23:10,151 --> 00:23:11,652
RESPONSE TO EEVERL SUPER AN

604
00:23:11,652 --> 00:23:12,720
STUDIES THAT WERE NOW

605
00:23:12,720 --> 00:23:15,289
REPLICATING WHAT WE HAD FOUND IN

606
00:23:15,289 --> 00:23:18,025
THE WISE AND AGAIN, A PATIENTS

607
00:23:18,025 --> 00:23:20,094
IN THE CLINICCORRAL OR CENTRAL

608
00:23:20,094 --> 00:23:21,929
FIGURE DEMON TRAITING THAT WHEN

609
00:23:21,929 --> 00:23:24,799
WOMEN LOOK LIKE MEN, WHEN

610
00:23:24,799 --> 00:23:27,668
THEY'RE ANGIOGRAMS LOOK LIKE MEN

611
00:23:27,668 --> 00:23:29,870
IN AN OBSTRUCTIVE CORONARY

612
00:23:29,870 --> 00:23:33,341
DISEASE MALE PATTERN, MORE MEN

613
00:23:33,341 --> 00:23:33,908
RECEIVE TREATMENT.

614
00:23:33,908 --> 00:23:37,378
WHEN WOMEN LOOK LIKE WOMEN, MALE

615
00:23:37,378 --> 00:23:39,580
OR FEMALE PATTERN MICROVASCULAR

616
00:23:39,580 --> 00:23:41,716
CAD, MORE WOMEN DIE.

617
00:23:41,716 --> 00:23:44,785
AND THIS IS BECAUSE OF A LACK OF

618
00:23:44,785 --> 00:23:46,420
TREATMENT, WE TESTED THAT

619
00:23:46,420 --> 00:23:48,823
HYPOTHESIS AS WE WENT FORWARD

620
00:23:48,823 --> 00:23:51,859
WITH THESE PHARMAICOLOGGIC PROBE

621
00:23:51,859 --> 00:23:52,093
TRIALS.

622
00:23:52,093 --> 00:23:54,161
GUIDELINES THERAPY, IF IT LOOKS

623
00:23:54,161 --> 00:23:56,464
LIKE YOU HAVE ISOTOPE KEEMIC

624
00:23:56,464 --> 00:23:59,166
HEART DISEASE IS ASSPRIN, BETA

625
00:23:59,166 --> 00:24:01,102
BLOCKER, ACE AND STATIN, THESE 4

626
00:24:01,102 --> 00:24:02,269
PILLS IF YOU WILL CONTINUE TO

627
00:24:02,269 --> 00:24:05,373
TAKE THEM, YOU WILL SEE YOUR

628
00:24:05,373 --> 00:24:06,007
CARDIOLOGIST A YEAR LATER, YOU

629
00:24:06,007 --> 00:24:08,242
WILL NOT HAVE DIED FROM YOUR

630
00:24:08,242 --> 00:24:09,276
CARDIOVASCULAR DISEASE, THIS IS

631
00:24:09,276 --> 00:24:10,644
STRONG EVIDENCE BUT IT HAD NOT

632
00:24:10,644 --> 00:24:13,681
BEEN TESTED IN FEMALE PATTERN.

633
00:24:13,681 --> 00:24:15,516
WE HAD INCORPORATED IPT GREATER

634
00:24:15,516 --> 00:24:17,985
CREASINGLY, THIS INTO CLINICAL

635
00:24:17,985 --> 00:24:19,587
PRACTICE GUIDELINES, WHERE IF IT

636
00:24:19,587 --> 00:24:20,654
MATTERED, IF IT LOOKED LIKE

637
00:24:20,654 --> 00:24:24,959
THERE WAS A FEMALE PATTERN THAT

638
00:24:24,959 --> 00:24:27,895
SHOULD BE ON A DIFFERENT

639
00:24:27,895 --> 00:24:29,764
DECISION TREE IN CLINICAL

640
00:24:29,764 --> 00:24:30,831
PRACTICE GUIDE LINES WE WORKED

641
00:24:30,831 --> 00:24:34,602
HARD TO GET THESE INTO

642
00:24:34,602 --> 00:24:34,902
GUIDELINES.

643
00:24:34,902 --> 00:24:35,770
THE GUIDELINE IMPLEMENTATION

644
00:24:35,770 --> 00:24:36,604
WHICH WAS OCCURRING AROUND THE

645
00:24:36,604 --> 00:24:40,141
TIME THAT WE WERE DOING THESE

646
00:24:40,141 --> 00:24:42,209
MECHANISTIC TRIALS, BUT THIS WAS

647
00:24:42,209 --> 00:24:45,613
SORT OF A GOOD START, AND WORK

648
00:24:45,613 --> 00:24:49,216
DONE BY ANOTHER GROUP, AND IT

649
00:24:49,216 --> 00:24:51,585
JUST SHOWS YOU PREAND POST

650
00:24:51,585 --> 00:24:54,155
TRANSITION OF THE GUIDELINE

651
00:24:54,155 --> 00:24:55,756
IMPLEMENTATION, MUCH OF THIS CO

652
00:24:55,756 --> 00:24:57,224
INSIDED WITH OUR AMERICAN

653
00:24:57,224 --> 00:24:59,427
COLLEGE OF CARDIOLOGY GUIDELINE

654
00:24:59,427 --> 00:25:00,961
CAMPAIGN, AND BASICALLY IF YOU

655
00:25:00,961 --> 00:25:03,664
HAD AN ACS, OR AN ACUTE

656
00:25:03,664 --> 00:25:04,365
MYOCARDIAL INFARCTION, YOU

657
00:25:04,365 --> 00:25:06,667
NEEDED TO LEAVE THE HOSPITAL ON

658
00:25:06,667 --> 00:25:10,204
THOSE 4 DRUGS, UNLESS THERE WAS

659
00:25:10,204 --> 00:25:11,939
A STRONG CONTRA INDICATION THIS

660
00:25:11,939 --> 00:25:13,541
FIGURE IS NOT PARTICULARLY

661
00:25:13,541 --> 00:25:15,176
UNDERSTANDABLE, SO I COLOR

662
00:25:15,176 --> 00:25:17,845
COATED IT, SO FOLLOWING

663
00:25:17,845 --> 00:25:18,879
GUIDELINE IMPLEMENTATION, THE

664
00:25:18,879 --> 00:25:20,848
MORTALITY FOR WOMEN IMPROVED,

665
00:25:20,848 --> 00:25:30,391
AND THE SEX GAP NARROWS.

666
00:25:30,391 --> 00:25:32,460
THE MALE HERE PRE AND POST

667
00:25:32,460 --> 00:25:34,061
DIDN'T REALLY CHANGE.

668
00:25:34,061 --> 00:25:35,229
WELL WHY?

669
00:25:35,229 --> 00:25:36,730
THERE ANGIOGRAMS WERE SOMETHING

670
00:25:36,730 --> 00:25:37,665
THE DOCTOR COULD DIAGNOSE AND

671
00:25:37,665 --> 00:25:40,468
SAY I KNOW HOW TO TREAT THAT AND

672
00:25:40,468 --> 00:25:41,969
THEY GOT TREATED.

673
00:25:41,969 --> 00:25:44,605
THE PERSISTENT SEX GAP, SMALL,

674
00:25:44,605 --> 00:25:46,273
BUT REAL AND WE'RE TALKING ABOUT

675
00:25:46,273 --> 00:25:48,109
HUNDREDS OF THOUSANDS OF LIVES

676
00:25:48,109 --> 00:25:51,846
EVERY YEAR IN OUR COUNTRY, THE

677
00:25:51,846 --> 00:25:52,913
PERSISTENT SEX GAP SUGGESTS THAT

678
00:25:52,913 --> 00:25:55,416
MORE WORK IS NEEDED TO

679
00:25:55,416 --> 00:25:56,217
UNDERSTAND SEX SPECIFIC

680
00:25:56,217 --> 00:25:57,852
PATHOPHYSIOLOGY TO IMPROVE THESE

681
00:25:57,852 --> 00:26:01,922
OUTCOMES IN WOMEN AND MEN.

682
00:26:01,922 --> 00:26:03,891
SO JUST WITH GUIDE LINE

683
00:26:03,891 --> 00:26:05,493
CAMPAIGNS ALONE BEFORE WE REALLY

684
00:26:05,493 --> 00:26:08,796
NEW HOW TO TREAT THOSE, WE SAW A

685
00:26:08,796 --> 00:26:10,831
PRETTY DRAMATIC IMPROVEMENT IN

686
00:26:10,831 --> 00:26:12,900
CARDIOVASCULAR DEC DEATH RATES,

687
00:26:12,900 --> 00:26:15,236
IN WOMEN, IT WAS ALSO GOING DOWN

688
00:26:15,236 --> 00:26:17,071
IN MEN, SO, MIGHT HAVE BEEN

689
00:26:17,071 --> 00:26:18,906
SOMETHING IN THE WATER BUT WE

690
00:26:18,906 --> 00:26:21,375
LIKE TO THINK THAT THESE

691
00:26:21,375 --> 00:26:23,344
GUIDELINE CAMPAIGNS REALLY HAVE

692
00:26:23,344 --> 00:26:25,679
BEEN DEMONSTRATED TO SAVE LIVES

693
00:26:25,679 --> 00:26:28,516
AND WHAT WE SAW CLEARLY IN THE

694
00:26:28,516 --> 00:26:32,153
WOMEN WHICH HAD BEEN PREVIOUSLY

695
00:26:32,153 --> 00:26:34,555
HERETOFORE STILL GOING UP,

696
00:26:34,555 --> 00:26:37,791
RIGHT, THAT A 43% IN

697
00:26:37,791 --> 00:26:41,862
CARDIOVASCULAR DEC MORTALITY.

698
00:26:41,862 --> 00:26:43,664
MORTAL--DISEASE MORETALLITY.

699
00:26:43,664 --> 00:26:45,299
SO CONCURRENT WITH THESE

700
00:26:45,299 --> 00:26:46,167
CAMPAIGN WE LAUNCHED THESE

701
00:26:46,167 --> 00:26:48,602
INTERVENTION AND WE CALLED THESE

702
00:26:48,602 --> 00:26:49,970
PHARMAICOLOGGIC PROBE TRIALS,

703
00:26:49,970 --> 00:26:50,204
WHY?

704
00:26:50,204 --> 00:26:52,806
BECAUSE WE HAD DRUGS, TIMES

705
00:26:52,806 --> 00:26:55,309
DEVICES BUT DOMINANTLY DRUGS WE

706
00:26:55,309 --> 00:26:57,711
HAD KNOWN PATHWAY EFFECT EMPLOY

707
00:26:57,711 --> 00:26:59,914
SO USING PHARMACOLOGY TO THEN

708
00:26:59,914 --> 00:27:02,116
TEASE OUT MECHANISTIC PATHWAYS.

709
00:27:02,116 --> 00:27:03,417
AND WHAT WE DEMON TRAITED EARLY

710
00:27:03,417 --> 00:27:09,757
ON IS ACE INHIBITORS, QUINIPRIL

711
00:27:09,757 --> 00:27:13,494
IS AN ANGIO TENSEIN INHIBITOR,

712
00:27:13,494 --> 00:27:14,595
NOT ONLY IMPROVED CORONARY FLOW

713
00:27:14,595 --> 00:27:18,766
IN THE SMALL VESSELS BUT WAS

714
00:27:18,766 --> 00:27:20,234
ANTIANGINNAL, AT 16 WEEKS OF

715
00:27:20,234 --> 00:27:22,236
TREATMENT, NOBODY THOUGHT THAT

716
00:27:22,236 --> 00:27:25,406
THIS WOULD DRUG WOULD IMPROVE

717
00:27:25,406 --> 00:27:27,408
ANG INA, OTHERS WERE NOT SO

718
00:27:27,408 --> 00:27:30,344
SUCCESSFUL, WE TRIED LOW DOSE

719
00:27:30,344 --> 00:27:31,812
HORMONE REPLACEMENT THERAPY.

720
00:27:31,812 --> 00:27:32,880
I'LL ALWAYS HAPPY TO TAKE

721
00:27:32,880 --> 00:27:34,582
QUESTIONS ABOUT HRT BUT I WILL

722
00:27:34,582 --> 00:27:36,584
JUST TELL YOU WOMEN ARE NOT JUST

723
00:27:36,584 --> 00:27:38,319
HORMONES AND WE LEARNED THAT

724
00:27:38,319 --> 00:27:38,819
LESSON.

725
00:27:38,819 --> 00:27:40,287
WE DIDN'T HAVE ANY ADVERSE

726
00:27:40,287 --> 00:27:44,158
EFFECTS, AND WE THINK THAT THEY

727
00:27:44,158 --> 00:27:45,659
THOUGHT THEIR AN GUINA WAS

728
00:27:45,659 --> 00:27:50,097
BETTER BECAUSE THEIR HOT FLASHES

729
00:27:50,097 --> 00:27:52,866
WERE BETTER.

730
00:27:52,866 --> 00:27:55,336
WISE, ETHIN ILLEGALS A PD5

731
00:27:55,336 --> 00:27:56,403
INHIBITOR DID NOT APPEAR TO HELP

732
00:27:56,403 --> 00:28:00,908
AND AN EARLY USE OF A DRUG

733
00:28:00,908 --> 00:28:03,010
RANOLAZINE, ONLY 1 IN ITS CLASS,

734
00:28:03,010 --> 00:28:04,545
NOBODY REALLY KNOWS HOW IT, WOS,

735
00:28:04,545 --> 00:28:05,379
DIDN'T SEEM TO WORK.

736
00:28:05,379 --> 00:28:07,114
SO WE HAD OUR WORK CUT OUT FOR

737
00:28:07,114 --> 00:28:08,983
US THEN TO TRY TO TRANSLATE

738
00:28:08,983 --> 00:28:12,987
THIS, SO NOW THAT WE KNEW AND

739
00:28:12,987 --> 00:28:15,422
PREVIOUS WORK DONE AT MAYO AND

740
00:28:15,422 --> 00:28:17,858
THE BRIGHAM DEMON TRAITED HIGH

741
00:28:17,858 --> 00:28:19,026
INSTENSITY STATINS AND WE WORKED

742
00:28:19,026 --> 00:28:21,729
THEN TO TRANSLATE THIS.

743
00:28:21,729 --> 00:28:23,597
O THIS IS THE WARRIOR TRIAL

744
00:28:23,597 --> 00:28:25,799
WHICH IS ONGOING, WOMEN'S

745
00:28:25,799 --> 00:28:27,868
ISCHEMIA TREATMENT REDUCES

746
00:28:27,868 --> 00:28:29,203
EVENTS IN NONOBSTRUCTIVE C,A D,

747
00:28:29,203 --> 00:28:30,504
THE INVESTIGATORS AS CAN YOU SEE

748
00:28:30,504 --> 00:28:34,908
ARE LISTED THERE, AS DESIGNED

749
00:28:34,908 --> 00:28:37,311
AND FUNDED BY OUR CONGRESSALLY

750
00:28:37,311 --> 00:28:42,349
DIRECTED RESEARCH PROGRAM OF THE

751
00:28:42,349 --> 00:28:43,984
D.O.D., 4422 SUBRECYCLINGS WITH

752
00:28:43,984 --> 00:28:47,388
AN BEGINNA AND NO OBSTRUCTIVE

753
00:28:47,388 --> 00:28:48,522
CORONARY DISEASE RANDOMIZE 2

754
00:28:48,522 --> 00:28:50,624
INDENSIVE MEDICAL THERAPY WHICH

755
00:28:50,624 --> 00:28:52,926
IS, YOU KNOW HIGH INTENSITY

756
00:28:52,926 --> 00:28:58,232
STATIN, MACK MALLY TOLERATED ACE

757
00:28:58,232 --> 00:29:03,971
OR ARB, AND THAT WAS FOR THE

758
00:29:03,971 --> 00:29:06,607
REDUCTION OF MACE,

759
00:29:06,607 --> 00:29:10,511
HOSPITALIZATION, STROKE,

760
00:29:10,511 --> 00:29:11,712
NONFATAL MI OR HEART FAILURE.

761
00:29:11,712 --> 00:29:13,914
THIS IS OPEN CARE RANDOMIZATION,

762
00:29:13,914 --> 00:29:16,250
OPEN LABEL DONE IN THE CLINIC

763
00:29:16,250 --> 00:29:17,251
USING REPURPOSES FDA APPROVED

764
00:29:17,251 --> 00:29:20,988
DRUGS THAT ARE EASY AND VERY

765
00:29:20,988 --> 00:29:24,825
ECONOMICAL NOW IN CARDIOLOGY AND

766
00:29:24,825 --> 00:29:27,494
USED EVERY DAY IN CARDIOLOGY AND

767
00:29:27,494 --> 00:29:28,862
INTERNAL MEDICINE OFFICES AND

768
00:29:28,862 --> 00:29:32,366
USUAL CARE WE DID NOT INTERRUPT

769
00:29:32,366 --> 00:29:34,902
ANY CARE, BUT WE HEIGHTENED CARE

770
00:29:34,902 --> 00:29:38,872
IN THE VAST MAJORITY OF

771
00:29:38,872 --> 00:29:39,139
PATIENTS.

772
00:29:39,139 --> 00:29:43,911
THIS HAS RELEVANCE TO ANOTHER

773
00:29:43,911 --> 00:29:47,381
EPIDEMIC CALLED 22 MI, WE TALKED

774
00:29:47,381 --> 00:29:51,885
ABOUT NSTEM I AND STEMI, BUT

775
00:29:51,885 --> 00:29:53,787
WE'RE HAVING A CHANGE OF HEART

776
00:29:53,787 --> 00:29:54,521
ATTACKS PROBABLY BECAUSE OF THE

777
00:29:54,521 --> 00:29:57,057
WIDE SPREAD USE OF STATINS AND

778
00:29:57,057 --> 00:30:01,595
OVER THE COUNTER ASPIRIN, TO

779
00:30:01,595 --> 00:30:02,963
TYPE 2 MYOCARDIAL INFARCTION,

780
00:30:02,963 --> 00:30:05,499
RISE AND FALL OF BIOMARKERS,

781
00:30:05,499 --> 00:30:06,834
EVIDENCE OF ISCHEMIA BUT IT IS

782
00:30:06,834 --> 00:30:09,169
TUE TO A MISMATCH IN THE

783
00:30:09,169 --> 00:30:11,338
MYOCARDIAL OXYGEN SUPPLY AND

784
00:30:11,338 --> 00:30:13,307
DEMAND AND TYPICALLY OPEN

785
00:30:13,307 --> 00:30:19,713
ARTERIES, VAST MAIORITY  MAIOR-Y

786
00:30:19,713 --> 00:30:21,248
OF THE TIME, IT IS DOMINATED BY

787
00:30:21,248 --> 00:30:23,183
WOMEN BUT NOT ALL WOMEN BECAUSE

788
00:30:23,183 --> 00:30:28,589
TYPE 1 M. I. THE GOOD OLD BAD

789
00:30:28,589 --> 00:30:29,890
STEMIs, PLAQUE, RUPTURE, MILD

790
00:30:29,890 --> 00:30:33,327
OR NO PLAQUE OR FIXED BUT NOT A

791
00:30:33,327 --> 00:30:37,631
PLAQUE RUPTURE AND THIS IS

792
00:30:37,631 --> 00:30:38,432
DOMINATED BY WOMEN.

793
00:30:38,432 --> 00:30:40,033
BECAUSE WE HAD DONE ALL THE

794
00:30:40,033 --> 00:30:41,568
STUDY IN THE WISE, WE DO THINK

795
00:30:41,568 --> 00:30:44,972
THAT THIS IS HELPFUL, MEANING,

796
00:30:44,972 --> 00:30:46,974
WE ARE NOW INFORMING BECAUSE WE

797
00:30:46,974 --> 00:30:48,675
DID THIS DEEP PHENOTYPING, WE

798
00:30:48,675 --> 00:30:52,112
HAVE MUCH BETTER MECHANISTIC

799
00:30:52,112 --> 00:30:53,580
UNDERSTANDING THAT WE NOW ARE

800
00:30:53,580 --> 00:30:57,751
ABLE TO FOR EXAMPLE, HELP WITH

801
00:30:57,751 --> 00:30:59,953
THESE USE IN PRACTICE, LOW TYPE

802
00:30:59,953 --> 00:31:03,624
2 MI RISK, HIGH TYPE 2 MI RISK,

803
00:31:03,624 --> 00:31:06,160
AND ONGOING AND STARTING TRIALS

804
00:31:06,160 --> 00:31:10,531
NOW ARE TESTING NOW SHOULD THESE

805
00:31:10,531 --> 00:31:10,964
PATIENTS BE TREATED?

806
00:31:10,964 --> 00:31:12,533
THESE PATIENTS APPEAR TO HAVE

807
00:31:12,533 --> 00:31:14,535
MINIMAL RISK SO BETTER

808
00:31:14,535 --> 00:31:15,369
PHENOTYPES, BETTER PRECISION

809
00:31:15,369 --> 00:31:17,204
CARE AND HOPEFULLY BETTER HEALTH

810
00:31:17,204 --> 00:31:19,773
AS A RESULT OF RANDOMIZED

811
00:31:19,773 --> 00:31:20,541
CONTROLLED TRIALS.

812
00:31:20,541 --> 00:31:24,945
THE TYPE 2 MI ALSO THANKS THE

813
00:31:24,945 --> 00:31:26,680
STUDY OF WOMEN AND HERSTORY

814
00:31:26,680 --> 00:31:28,682
BECAUSE WE HAVE NEW CHEST PAIN

815
00:31:28,682 --> 00:31:30,417
GUIDELINES THAT JUST CAME OUT A

816
00:31:30,417 --> 00:31:32,986
YEAR AND A HALF AGO AND WE HAVE

817
00:31:32,986 --> 00:31:35,189
AS A MENTIONED PREVIOUSLY NEW

818
00:31:35,189 --> 00:31:37,257
ICD10 CODES SO NOW, PHYSICIANS

819
00:31:37,257 --> 00:31:38,892
CAN ACTUALLY BILL WHEN THEY

820
00:31:38,892 --> 00:31:41,328
TREAT THESE CONDITIONS, WHICH

821
00:31:41,328 --> 00:31:44,932
PREVIOUSLY WE DIDN'T THINK THEY

822
00:31:44,932 --> 00:31:45,399
WERE REAL.

823
00:31:45,399 --> 00:31:48,735
SO FACED WITH A PATIENT WITH

824
00:31:48,735 --> 00:31:49,369
NONOBSTRUCTIVE STENOSIS, IT IS

825
00:31:49,369 --> 00:31:51,038
VERY CLEAR NOW THEY SHOULD BE

826
00:31:51,038 --> 00:31:55,008
TREATED, THEY SHOULD BE GIVEN

827
00:31:55,008 --> 00:31:56,410
MEDICATIONS BECAUSE THEY'VE HAD

828
00:31:56,410 --> 00:31:58,278
A HEART ATTACK, UNLIKE OUR

829
00:31:58,278 --> 00:31:59,313
WARRIOR TRIAL AND THAT THE

830
00:31:59,313 --> 00:32:01,048
PHYSICIANS NOW CAN USE THESE

831
00:32:01,048 --> 00:32:03,083
CODES AND THEY UNDERSTAND ALSO

832
00:32:03,083 --> 00:32:04,384
HOW THEY WOULD DIAGNOSE THIS

833
00:32:04,384 --> 00:32:04,618
PATIENT.

834
00:32:04,618 --> 00:32:07,254
THIS WAS A CENTRAL FIGURE WITH

835
00:32:07,254 --> 00:32:11,291
MY COLLEAGUE DR. MARTHA GULATI,

836
00:32:11,291 --> 00:32:12,726
ANOTHER EXAMPLE OF GUIDELINES,

837
00:32:12,726 --> 00:32:15,863
IMPACT AND RETURN ON INVESTMENT,

838
00:32:15,863 --> 00:32:17,598
ECONOMISTS AT THE CONGRESSIONAL

839
00:32:17,598 --> 00:32:18,899
BUDGET OFFICE DESCRIBED A HIEWM

840
00:32:18,899 --> 00:32:21,235
REDUCTION IN ITS MEDICARE

841
00:32:21,235 --> 00:32:25,506
FORECAST BETWEEN 2010 AND 2020.

842
00:32:25,506 --> 00:32:27,040
MOST OF THESE REDUCTIONS CAME

843
00:32:27,040 --> 00:32:28,342
FROM CHANGES TO PUBLIC HEALTH

844
00:32:28,342 --> 00:32:30,544
AND THE PRACTICE OF MEDICINE

845
00:32:30,544 --> 00:32:31,912
ITSELF AND SPECIFICALLY OLDER

846
00:32:31,912 --> 00:32:33,914
AMERICANS ARE HAVING FEWER HEART

847
00:32:33,914 --> 00:32:35,449
ATTACKS AND STROKES, AND THE

848
00:32:35,449 --> 00:32:37,918
LIKELY RESULT OF EFFECTIVE

849
00:32:37,918 --> 00:32:40,420
CHOLESTEROL AND BLOOD PRESSURE

850
00:32:40,420 --> 00:32:40,687
MEDICINES.

851
00:32:40,687 --> 00:32:44,124
AND SO THIS IS AN EXAMPLE AGAIN

852
00:32:44,124 --> 00:32:46,426
OF NIH AND RETURN ON INVESTMENT.

853
00:32:46,426 --> 00:32:48,729
AND WE NEED TO JUST POUND THAT

854
00:32:48,729 --> 00:32:49,863
DRUM ALL THE TIME.

855
00:32:49,863 --> 00:32:52,299
EVERY TIME WE ARE ASKING FOR

856
00:32:52,299 --> 00:32:55,102
BUNLETS, WE'RE ASKING FOR

857
00:32:55,102 --> 00:33:01,909
RESOLUTIONS, IT'S CRITICALLY

858
00:33:01,909 --> 00:33:02,476
IMPORTANT.

859
00:33:02,476 --> 00:33:03,911
SO HERE'S WHERE WE WERE THEN AS

860
00:33:03,911 --> 00:33:05,312
WE DID THESE PROBE TRIALS AS WE

861
00:33:05,312 --> 00:33:07,548
GOT INTO THE NIGHER GUIDELINES

862
00:33:07,548 --> 00:33:08,749
AND NEWER CODING, ONCE AGAIN WE

863
00:33:08,749 --> 00:33:12,119
SAW A DROP TO THE POINT WHERE

864
00:33:12,119 --> 00:33:14,254
WOMEN NOW WERE AT PARITY WITH

865
00:33:14,254 --> 00:33:15,689
MEN SHOWN IN THE RED LINE

866
00:33:15,689 --> 00:33:18,125
COMPARED TO THE BLUE LINE ASKING

867
00:33:18,125 --> 00:33:19,993
IS THIS OPTIMAL FOR WOMEN?

868
00:33:19,993 --> 00:33:22,329
BECAUSE WOMEN USED TO DO BETTER

869
00:33:22,329 --> 00:33:23,931
THAN MEN AND WOMEN CONTINUE TO

870
00:33:23,931 --> 00:33:26,833
HAVE A LONGER LIFE SPAN ON

871
00:33:26,833 --> 00:33:29,202
AVERAGE THAN MEN, SORT OF BUILT

872
00:33:29,202 --> 00:33:32,673
TO LAST MIGHT BE 1 OF THE

873
00:33:32,673 --> 00:33:34,575
PHYSIOLOGIC DIFFERENCES AND SO

874
00:33:34,575 --> 00:33:36,610
THAT IS THE QUESTION.

875
00:33:36,610 --> 00:33:39,179
SHOULD IT BE DOWN HERE IN IS

876
00:33:39,179 --> 00:33:41,548
THERE MORE WORK TO BE DONE?

877
00:33:41,548 --> 00:33:44,518
AND INDEED EVEN BEFORE THE

878
00:33:44,518 --> 00:33:46,019
PANDEMIC AN ASSOCIATED AS WE

879
00:33:46,019 --> 00:33:53,727
READ ON DEATHS OF DESPAIR AND

880
00:33:53,727 --> 00:33:55,529
ERODING LIFESTYLE PRACTICES,

881
00:33:55,529 --> 00:33:57,264
BOTH WOMEN AND MENS

882
00:33:57,264 --> 00:33:58,298
CARDIOVASCULAR DEC IS ON THE

883
00:33:58,298 --> 00:34:01,201
RISE AND WAS AIDED AND ABETTED

884
00:34:01,201 --> 00:34:04,805
BY THE PANDEMIC, SO FOR THOSE OF

885
00:34:04,805 --> 00:34:05,672
YOU IN CARDIOLOGY,

886
00:34:05,672 --> 00:34:06,974
CARDIOVASCULAR DISEASE AND ALL

887
00:34:06,974 --> 00:34:08,408
OF ITS RELATED DISCIPLINES WE

888
00:34:08,408 --> 00:34:12,079
ARE ASSURED OF A JOB

889
00:34:12,079 --> 00:34:12,412
UNFORTUNATELY.

890
00:34:12,412 --> 00:34:15,248
YEAH, MORE WORK AHEAD.

891
00:34:15,248 --> 00:34:17,351
ALL RIGHT, SO NOT YOUR FATHER'S

892
00:34:17,351 --> 00:34:21,488
HEART DISEASE, THE HERSTORY AND

893
00:34:21,488 --> 00:34:25,626
THE NHLBI'S SPONSOREDS WITH,

894
00:34:25,626 --> 00:34:28,962
OBSERVINGAL STUDIES CONTINUE TO

895
00:34:28,962 --> 00:34:29,796
DEMONSTRATE THAT INOCA IS COMMON

896
00:34:29,796 --> 00:34:31,131
IN WOMEN, I DIDN'T SHOW THE DATA

897
00:34:31,131 --> 00:34:33,300
IN THE INTEREST OF TIME BUT IT'S

898
00:34:33,300 --> 00:34:36,203
COMING IN YOUNG MIDLIFE WOMEN,

899
00:34:36,203 --> 00:34:36,803
PREMENOPAUSAL WOMEN MEANING

900
00:34:36,803 --> 00:34:40,741
BETWEEN THE AGES OF 45 AND 55,

901
00:34:40,741 --> 00:34:41,408
MECHANISMS INCLUDE TRADITIONAL

902
00:34:41,408 --> 00:34:42,476
CARDIAC RISK FACTORS,A

903
00:34:42,476 --> 00:34:51,818
LOS ANGELES AS --AS WELL AS NOVL

904
00:34:51,818 --> 00:34:53,687
SPECIFIC RISK FACTORS, AND

905
00:34:53,687 --> 00:34:54,855
INTERVENTIONAL TRIALS SUPPORT

906
00:34:54,855 --> 00:34:55,789
TRADITIONAL AND NOVEL

907
00:34:55,789 --> 00:34:56,490
INTERVENTIONS AND TRANSLATIONAL

908
00:34:56,490 --> 00:34:58,458
WORK IS ONGOING TO PROMOTE

909
00:34:58,458 --> 00:34:59,426
INVESTIGATIVE FINDINGS INTO

910
00:34:59,426 --> 00:35:00,694
GUIDELINES AND CLINICAL PRACTICE

911
00:35:00,694 --> 00:35:01,495
RESEARCH TOYS IMPROVE HUMAN

912
00:35:01,495 --> 00:35:05,999
HEALTH AS WELL AS ELIMINATE

913
00:35:05,999 --> 00:35:08,035
THESE SEX-RELATED CARDIOVASCULAR

914
00:35:08,035 --> 00:35:08,368
DISPARITIES.

915
00:35:08,368 --> 00:35:11,171
THIS IS WHERE WE ARE IN TERMS OF

916
00:35:11,171 --> 00:35:15,342
IMETTING UP AND TO A MORE

917
00:35:15,342 --> 00:35:15,742
CONTEMPORARY AREA.

918
00:35:15,742 --> 00:35:20,747
AND IT IS A PARALLELLING THE

919
00:35:20,747 --> 00:35:23,250
DECLINE, THE RED LINE FROM

920
00:35:23,250 --> 00:35:24,184
CARDIOVASCULAR DEC, THIS IS

921
00:35:24,184 --> 00:35:26,753
TRYING TO HELP US UNDERSTAND THE

922
00:35:26,753 --> 00:35:28,388
RETURN ON INVESTMENT AND WHY

923
00:35:28,388 --> 00:35:30,457
INVESTING IN WOMEN'S HEALTH IN

924
00:35:30,457 --> 00:35:31,258
PARTICULAR RECENTLY ACKNOWLEDGED

925
00:35:31,258 --> 00:35:35,696
BY THE WHITE HOUSE, IS

926
00:35:35,696 --> 00:35:36,430
CRITICALLY IMPORTANT NOT ONLY

927
00:35:36,430 --> 00:35:37,364
BECAUSE IT'S THE RIGHT THING TO

928
00:35:37,364 --> 00:35:40,200
DO BUT IT TURNS OUT TO BE PRETTY

929
00:35:40,200 --> 00:35:42,002
GOOD ECONOMIC INVESTMENT, WE ARE

930
00:35:42,002 --> 00:35:44,337
CONTINUING IN OUR WISE STUDIES,

931
00:35:44,337 --> 00:35:47,207
ON THE BASIS OF THE HEART

932
00:35:47,207 --> 00:35:48,608
FAILURE PROGNOSIS, IF YOU RECALL

933
00:35:48,608 --> 00:35:55,449
1 OF THOSE EARLY SLIDES IN THE

934
00:35:55,449 --> 00:35:56,983
OBSERVATION SECTION, THAT THE

935
00:35:56,983 --> 00:35:58,018
MAJORITY OF ADVERSE EVENTS IN

936
00:35:58,018 --> 00:35:59,419
WOMEN ARE NOT HEART ATTACKS

937
00:35:59,419 --> 00:36:00,620
ALTHOUGH WE MAY HAVE MISSED THEM

938
00:36:00,620 --> 00:36:03,090
BECAUSE OF THE LACK OF THE TIME

939
00:36:03,090 --> 00:36:05,158
OF HIGH SENSITIVITY, TNI, TRIP

940
00:36:05,158 --> 00:36:07,260
OWNIN, BUT THEY CLEARLY GO INTO

941
00:36:07,260 --> 00:36:10,964
HEART FAILURE, AND SO THIS IS

942
00:36:10,964 --> 00:36:12,399
PROBABLY THE FODDER FOR HEART

943
00:36:12,399 --> 00:36:13,667
FAILURE WITH PRESERVED EJECTION

944
00:36:13,667 --> 00:36:17,771
FRACTION WHICH IS A NEW EPIDEMIC

945
00:36:17,771 --> 00:36:20,006
OF THE LAST 20 YEAR ANDS THESE

946
00:36:20,006 --> 00:36:21,508
ARE INVESTIGATORS WORKING WITH

947
00:36:21,508 --> 00:36:25,212
US COLLABORATIVELY AND ON OUR

948
00:36:25,212 --> 00:36:28,215
TEAM TO UNDERSTAND PATHWAYS TO

949
00:36:28,215 --> 00:36:31,017
HEART FAILURE WITH PRESERVED

950
00:36:31,017 --> 00:36:33,053
EJECTION FRACTION, FONDLY TERMED

951
00:36:33,053 --> 00:36:36,256
HEFP A TH, AND WE ARE WORKING

952
00:36:36,256 --> 00:36:42,162
VERY HARD AT UNDERSTANDING NOT

953
00:36:42,162 --> 00:36:43,630
ONLY SUBENDOCARDIAL ISCHEMIA BUT

954
00:36:43,630 --> 00:36:45,532
IN DOCUMENTING THAT THE TISSUES

955
00:36:45,532 --> 00:36:48,034
ARE ACTUALLY ISOTOPE KEEMIC

956
00:36:48,034 --> 00:36:50,203
USING MR SPECTROSCOPY BUT ALSO

957
00:36:50,203 --> 00:36:51,838
LOOKING AT WHY DOES THE HEART

958
00:36:51,838 --> 00:36:54,074
GET STIFF, AND IT APPEARS TO BE

959
00:36:54,074 --> 00:36:57,477
INFILTRATED IN MANY OF THESE

960
00:36:57,477 --> 00:36:57,978
CASES WITH TRIGLYCERIDE,

961
00:36:57,978 --> 00:37:01,081
ACTUALLY FAT IN THE HEART

962
00:37:01,081 --> 00:37:03,717
MUSCLE, POTENTIALLY DUE TO

963
00:37:03,717 --> 00:37:05,018
METABOLIC DISREGULATION AND A

964
00:37:05,018 --> 00:37:08,188
SHIFT FROM 3 FATTY ACIDS TO

965
00:37:08,188 --> 00:37:10,757
FLUICOSE IN THE HIBERNATING

966
00:37:10,757 --> 00:37:12,259
MYOCARDIUM THAT IS OXYGEN

967
00:37:12,259 --> 00:37:12,492
STARVED.

968
00:37:12,492 --> 00:37:17,063
WE ARE ALSO LOOKING AT ADVERSE

969
00:37:17,063 --> 00:37:19,633
REMODELS AND DIFFUSE FIBROSIS IN

970
00:37:19,633 --> 00:37:21,868
ADDITION TO FOCAL FIBROSIS, HAD

971
00:37:21,868 --> 00:37:23,603
AND THEN LOOKING AT VERY

972
00:37:23,603 --> 00:37:25,806
CAREFULLY AT NOT ONLY STRAIN HOW

973
00:37:25,806 --> 00:37:27,774
MUCH THE HEART QUEEZS AND

974
00:37:27,774 --> 00:37:29,609
TWISTS, IT IS PUMPING BUT ALSO

975
00:37:29,609 --> 00:37:32,813
HOW THE VENTRICLES ARE WORKING

976
00:37:32,813 --> 00:37:34,581
SYNCHRONOUSLY AND HOW THE ATRIA

977
00:37:34,581 --> 00:37:36,349
AND THE VENTRICLES ARE WORKING

978
00:37:36,349 --> 00:37:40,787
TOGETHER AND ALL OF THESE ARE

979
00:37:40,787 --> 00:37:42,189
POTENTIAL MECHANISTIC TREATMENT

980
00:37:42,189 --> 00:37:46,293
TARGETS AGAIN FOR NOVEL OR

981
00:37:46,293 --> 00:37:47,093
EXISTING INTERVENTIONS.

982
00:37:47,093 --> 00:37:51,498
THIS IS OUR BENEFACTOR WHO

983
00:37:51,498 --> 00:37:54,334
RAISED THE MONEY BY GETTING HER

984
00:37:54,334 --> 00:38:00,440
NETWORK TO ENDOW OUR CENTER FOR

985
00:38:00,440 --> 00:38:03,009
RESEARCH AND POLICY, EDUCATION

986
00:38:03,009 --> 00:38:04,544
AND POLICY AND RESEARCH THAT WE

987
00:38:04,544 --> 00:38:06,179
WILL NEED SEED MONIES FOR AND

988
00:38:06,179 --> 00:38:08,348
THEN THE EDUCATION AND POLICY

989
00:38:08,348 --> 00:38:09,583
BECAUSE WE CANNOT WRITE GRANTS

990
00:38:09,583 --> 00:38:10,483
FOR THAT.

991
00:38:10,483 --> 00:38:13,920
SO, THAT MIGHT BE MY LAST SLIDE,

992
00:38:13,920 --> 00:38:15,655
HERE'S MY LAST SLIDE, SO I

993
00:38:15,655 --> 00:38:19,392
ALWAYS WANT TO THANK OUR

994
00:38:19,392 --> 00:38:20,861
PARTICIPANTS AND I'M ALWAYS

995
00:38:20,861 --> 00:38:22,963
HAPPY TO TALK TO INVESTIGATORS

996
00:38:22,963 --> 00:38:25,165
BECAUSE THE MANTRA IS THAT YOU

997
00:38:25,165 --> 00:38:26,566
CANNOT GET WOMEN TO VOLUNTEER

998
00:38:26,566 --> 00:38:27,968
FOR RESEARCH STUDIES AND WOO

999
00:38:27,968 --> 00:38:29,336
HAVE NOT FOUND THAT TO BE TRUE

1000
00:38:29,336 --> 00:38:30,070
AT ALL.

1001
00:38:30,070 --> 00:38:32,138
SO I'M ALWAYS HAPPY TO GIVE YOU

1002
00:38:32,138 --> 00:38:35,575
TIPS, STARTING WITH SOME FEMALE

1003
00:38:35,575 --> 00:38:36,710
INVESTIGATORS AS A GOOD FIRST

1004
00:38:36,710 --> 00:38:38,445
START, I WANT TO THANK MY

1005
00:38:38,445 --> 00:38:40,180
CLINICAL TEAM WHO DOES THIS

1006
00:38:40,180 --> 00:38:42,816
IMPORTANT WORK WITH OUR PATIENT

1007
00:38:42,816 --> 00:38:44,517
PARTICIPANTS, MY ADMIN TRAITIVE

1008
00:38:44,517 --> 00:38:46,386
TEAM AND MY COLLABORATORS AS

1009
00:38:46,386 --> 00:38:51,391
WELL AS MY CLINICIANS IN OUR

1010
00:38:51,391 --> 00:38:51,758
CENTER.

1011
00:38:51,758 --> 00:38:53,727
OKAY, SO, I'M ENDING ON TIME.

1012
00:38:53,727 --> 00:38:59,566
HAPPY TO TAKE QUESTIONS.

1013
00:38:59,566 --> 00:38:59,933
>> THANK YOU.

1014
00:38:59,933 --> 00:39:00,567
[ APPLAUSE ]

1015
00:39:00,567 --> 00:39:01,301
>> WE CERTAINLY WELCOME

1016
00:39:01,301 --> 00:39:02,402
QUESTIONS FROM THE AUDIENCE TO,

1017
00:39:02,402 --> 00:39:04,104
GET US GOING, I WASN'T ABLE TO

1018
00:39:04,104 --> 00:39:06,206
TYPE IT IN YET BUT THERE WAS A

1019
00:39:06,206 --> 00:39:07,173
QUESTION ABOUT PARTICIPATION IN

1020
00:39:07,173 --> 00:39:08,475
CLINICAL TRIALS SO MAYBE YOU CAN

1021
00:39:08,475 --> 00:39:12,479
EXPAND ON THAT LAST TIP YOU

1022
00:39:12,479 --> 00:39:12,913
SAID.

1023
00:39:12,913 --> 00:39:13,280
>> EXCELLENT.

1024
00:39:13,280 --> 00:39:14,247
NOW IF IT WAS A SPECIFIC

1025
00:39:14,247 --> 00:39:16,416
QUESTION TO THE WARRIOR

1026
00:39:16,416 --> 00:39:19,386
ENROLLMENT, DID END IN DECEMBER

1027
00:39:19,386 --> 00:39:21,554
AND WILL CLOSE FOLLOW UP OUT BY

1028
00:39:21,554 --> 00:39:21,721
UNI.

1029
00:39:21,721 --> 00:39:24,190
WE HAD--BECAUSE OF THE PANDEMIC,

1030
00:39:24,190 --> 00:39:27,727
AS YOU MIGHT IMAGINE, WE WERE

1031
00:39:27,727 --> 00:39:31,464
LIMPING ALONG BUT WE DID NOT

1032
00:39:31,464 --> 00:39:35,402
STOP AND SO WE'RE SOMEWHAT

1033
00:39:35,402 --> 00:39:36,703
UNDERENROLLED, WE WENT THROUGH

1034
00:39:36,703 --> 00:39:38,438
THANK YOU D.O.D. 3 COST

1035
00:39:38,438 --> 00:39:39,439
EXTENSIONS BUT WE ARE FINISHING

1036
00:39:39,439 --> 00:39:43,777
AND WE WILL HAVE RESULTS AT THE

1037
00:39:43,777 --> 00:39:45,412
AHA THIS COMING FALL.

1038
00:39:45,412 --> 00:39:46,780
SO UNFORTUNATELY THE QUESTION IS

1039
00:39:46,780 --> 00:39:49,849
YOU CANNOT ENROLL IN THAT

1040
00:39:49,849 --> 00:39:50,684
PARTICULAR STUDY, AND THEN ALL

1041
00:39:50,684 --> 00:39:52,285
OF OUR OTHER STUDIES PLEASE

1042
00:39:52,285 --> 00:39:55,422
SHOOT ME AN E-MAIL AND I'M HAPPY

1043
00:39:55,422 --> 00:40:01,728
TO TAKE REFERRALS OF PATIENTS OR

1044
00:40:01,728 --> 00:40:02,996
EVEN YOURSELF.

1045
00:40:02,996 --> 00:40:04,631
WE HAVE HISTORICALLY DONE WELL

1046
00:40:04,631 --> 00:40:06,566
FOR ENROLLMENT, I THINK THE

1047
00:40:06,566 --> 00:40:08,301
TRICKS ARE NUMBER 1, YOU CAN SEE

1048
00:40:08,301 --> 00:40:11,972
ON THIS PAGE A FAIR AMOUNT OF

1049
00:40:11,972 --> 00:40:14,574
FEMALE LEADERSHIP AND JUST LIKE

1050
00:40:14,574 --> 00:40:17,043
THAT PNAS STUDY THAT DEMON TRAIT

1051
00:40:17,043 --> 00:40:19,412
THAD FEMALE EMERGENCY DEPARTMENT

1052
00:40:19,412 --> 00:40:20,814
PHYSICIANS WERE BETTER AT TAKING

1053
00:40:20,814 --> 00:40:24,651
CARE IN TERMS OF OUTCOMES,

1054
00:40:24,651 --> 00:40:25,719
MORBIDITY AND MORTALITY OF HEART

1055
00:40:25,719 --> 00:40:28,121
ATTACK IF IT WAS CONGRUENT IF A

1056
00:40:28,121 --> 00:40:29,656
WOMAN DOCTOR WAS TAKING CARE OF

1057
00:40:29,656 --> 00:40:32,492
A WOMAN PATIENT, I THINK FOR

1058
00:40:32,492 --> 00:40:34,928
REASONS THAT ARE PROBABLY

1059
00:40:34,928 --> 00:40:39,466
RELATED TO THAT, OUR WOMEN FEEL

1060
00:40:39,466 --> 00:40:41,534
PRETTY CONFIDENT ABOUT, YOU KNOW

1061
00:40:41,534 --> 00:40:42,702
ENROLLING IN OUR CLINICAL TRIALS

1062
00:40:42,702 --> 00:40:45,038
AS WELL AS OUR OBSERVATIONAL 

1063
00:40:45,038 --> 00:40:46,106
STUDIES SO HAVING FEMALE

1064
00:40:46,106 --> 00:40:48,308
INVESTIGATORS AND STAFF ON YOUR

1065
00:40:48,308 --> 00:40:49,609
TEAM, NOT EXCLUSIVELY, AS YOU

1066
00:40:49,609 --> 00:40:53,046
CAN SEE, WE HAVE MEN AS WELL,

1067
00:40:53,046 --> 00:40:56,850
NUMBER 2, THE PROTOCOL NEEDS TO

1068
00:40:56,850 --> 00:41:00,086
BE FEMALE FRIENDLY.

1069
00:41:00,086 --> 00:41:01,755
WE OFFER STIPENDS FOR TRAVEL.

1070
00:41:01,755 --> 00:41:04,391
WE HAVE STIPENDS FOR DAYS AWAY

1071
00:41:04,391 --> 00:41:06,059
FROM WORK OR FOR ELDER CARE OR

1072
00:41:06,059 --> 00:41:09,129
CHILDCARE AND YOU CAN'T HAVE

1073
00:41:09,129 --> 00:41:12,065
THESE ENROLLMENT CRITERIA WHERE

1074
00:41:12,065 --> 00:41:14,067
NO 1 OVER 75 CAN--A LOT OF OVER

1075
00:41:14,067 --> 00:41:15,335
75 WOMEN WOULD LIKE TO

1076
00:41:15,335 --> 00:41:16,870
PARTICIPATE IN A HEART FAILURE

1077
00:41:16,870 --> 00:41:17,370
TRIAL.

1078
00:41:17,370 --> 00:41:24,778
SO THE PROTOCOLS NEED TO BE

1079
00:41:24,778 --> 00:41:25,145
FEMALE FRIENDLY.

1080
00:41:25,145 --> 00:41:26,446
AND YOU KNOW THESE ARE NOT THAT

1081
00:41:26,446 --> 00:41:28,314
HARD TO DO AND YET WHEN YOU LOOK

1082
00:41:28,314 --> 00:41:29,716
AROUND THEY'RE NOT DONE VERY

1083
00:41:29,716 --> 00:41:30,050
OFTEN.

1084
00:41:30,050 --> 00:41:33,319
SO I HOPE THAT'S HELPFUL NVERY

1085
00:41:33,319 --> 00:41:33,686
EXCITING, YEAH.

1086
00:41:33,686 --> 00:41:35,555
NTHANK YOU FOR A WONDERFUL TALK,

1087
00:41:35,555 --> 00:41:37,257
I AM ALAN [INDISCERNIBLE] FROM

1088
00:41:37,257 --> 00:41:38,691
HEART LUNG BLOOD INSTITUTE, I

1089
00:41:38,691 --> 00:41:40,660
WAS CURIOUS THAT THE LAST SLIDE

1090
00:41:40,660 --> 00:41:42,729
THAT YOU MENTIONEDS ARE THE TRI

1091
00:41:42,729 --> 00:41:43,897
DPLIS RIDE INFILTRATION AND

1092
00:41:43,897 --> 00:41:45,065
CARDIAC ISSUE AND PATIENTS WITH

1093
00:41:45,065 --> 00:41:48,268
HEART FAILURE, IS THERE ANY

1094
00:41:48,268 --> 00:41:49,769
ASSOCIATION WITH [INDISCERNIBLE]

1095
00:41:49,769 --> 00:41:52,472
RICH PROTEINS THEMSELVES WITH

1096
00:41:52,472 --> 00:41:53,306
THAT FINDING?

1097
00:41:53,306 --> 00:41:55,175
>> YEAH, THAT'S A GREAT

1098
00:41:55,175 --> 00:41:56,609
QUESTION.

1099
00:41:56,609 --> 00:41:58,044
WELL, SO, THE OTHER OBVIOUS

1100
00:41:58,044 --> 00:41:59,879
QUESTION IS, THOSE ARE THE

1101
00:41:59,879 --> 00:42:00,547
DIABETICS, RIGHT?

1102
00:42:00,547 --> 00:42:03,049
THAT THEY'RE THE 1S THAT HAVE

1103
00:42:03,049 --> 00:42:04,551
THE HIGH CIRCULATING BLOOD

1104
00:42:04,551 --> 00:42:06,152
GLUCOSE AND THAT DOESN'T APPEAR

1105
00:42:06,152 --> 00:42:09,422
TO BE TRUE, EITHER, WE GOT THE

1106
00:42:09,422 --> 00:42:12,125
IDEA, WELL WE HAD A

1107
00:42:12,125 --> 00:42:13,193
SPECTROSCOPIST AND SHE WAS VERY

1108
00:42:13,193 --> 00:42:14,494
INTERESTED IN THIS AND WE WENT

1109
00:42:14,494 --> 00:42:18,364
TO THE LITERATURE AND THERE ARE

1110
00:42:18,364 --> 00:42:22,502
YOU KNOW 1-OFF UNUSUAL GENETIC

1111
00:42:22,502 --> 00:42:23,970
DISORDERS, OFTEN CHILDREN, WHERE

1112
00:42:23,970 --> 00:42:26,072
THEY CANNOT USE FREE FATTY

1113
00:42:26,072 --> 00:42:31,878
ACIDS, THEY USE FLUICOSE AS THE

1114
00:42:31,878 --> 00:42:33,246
PRIMARY METABOLIC FUEL, AND IT'S

1115
00:42:33,246 --> 00:42:35,849
TURNING OUT TO BE TRUE.

1116
00:42:35,849 --> 00:42:39,986
WE ARE HALFWAY THROUGH HER R,

1117
00:42:39,986 --> 00:42:40,954
DR. JANET WAYS R, AND WE WILL

1118
00:42:40,954 --> 00:42:43,523
SEE HOW MUCH IT TURNS OUT TO BE

1119
00:42:43,523 --> 00:42:45,291
TRUE, BUT SO FAR, NO, DOESN'T

1120
00:42:45,291 --> 00:42:48,895
APPEAR TO BE RELATED TO THAT.

1121
00:42:48,895 --> 00:42:51,064
>> IT WOULD BE INTERESTING
TO

1122
00:42:51,064 --> 00:42:52,098
LOOK AT GOLDBERGARY WORK WHERE

1123
00:42:52,098 --> 00:42:53,533
HE DID PET SCANS IN PATIENTS

1124
00:42:53,533 --> 00:42:55,935
WITH GRIEK O PROTEIN LIPASE

1125
00:42:55,935 --> 00:42:56,703
DEFICIENCIES AND SHOWED

1126
00:42:56,703 --> 00:42:59,072
SWITCHING FROM FATTY ARK SID TO

1127
00:42:59,072 --> 00:43:01,040
GLUCOSE MAY CHANGE GENE

1128
00:43:01,040 --> 00:43:02,208
TRANSCRIPTION OF CARDIAC CELLS

1129
00:43:02,208 --> 00:43:04,077
AND MAYBE THAT'S A LINK THERE.

1130
00:43:04,077 --> 00:43:05,111
>> AND MAYBE THAT WAS 1 OF
THE

1131
00:43:05,111 --> 00:43:06,546
THINGS THAT WE LOOKEDDA THE THAT

1132
00:43:06,546 --> 00:43:09,916
WE SAW SPRMS OF NATURE, RIGHT?

1133
00:43:09,916 --> 00:43:14,220
, THAT WE WONDERED AND AGAIN,

1134
00:43:14,220 --> 00:43:15,922
THESE PATIENTS CLINICALLY, OFTEN

1135
00:43:15,922 --> 00:43:22,762
HAVE CHEST PAIN AT ALL RHYME OR

1136
00:43:22,762 --> 00:43:23,496
REASON, NOT EXERTIONAL CHEST

1137
00:43:23,496 --> 00:43:26,699
PAIN AND WITH OUR CURRENT COHORT

1138
00:43:26,699 --> 00:43:29,035
WE'RE FINISHING, WE ALSO

1139
00:43:29,035 --> 00:43:31,171
DEMONSTRATED BY SOMETHING SIMPLE

1140
00:43:31,171 --> 00:43:34,607
AS HAND GRIP, THEY LEAK

1141
00:43:34,607 --> 00:43:36,209
TRIPONIN, SO THE IDEA IS IF YOU

1142
00:43:36,209 --> 00:43:38,444
DO THIS LONG ENOUGH, THEY MAY

1143
00:43:38,444 --> 00:43:39,946
REALLY GENUINELY HAVE A FORM FOR

1144
00:43:39,946 --> 00:43:42,615
US TO WHAT WE WOULD CALL

1145
00:43:42,615 --> 00:43:43,383
HIBERNATING MYOCARDIUM, THERE

1146
00:43:43,383 --> 00:43:45,084
ARE CELLS THAT ARE JUST HANGING

1147
00:43:45,084 --> 00:43:48,521
ON BY THEIR FINGERNAILS AND THE

1148
00:43:48,521 --> 00:43:52,559
LEAST AMOUNT OF EFFORT CAN CAUSE

1149
00:43:52,559 --> 00:43:58,131
DAMAGE, AND THEN, SHIFT IN

1150
00:43:58,131 --> 00:43:59,399
METABOLISM, RIGHT, WE THINK, YOU

1151
00:43:59,399 --> 00:44:01,367
CAN TELL US IF THAT'S A KNOWN

1152
00:44:01,367 --> 00:44:03,269
MECHANISM BUT MORE IMPORTANTLY

1153
00:44:03,269 --> 00:44:05,605
THE SMALL LATE GATTA LIDIUM

1154
00:44:05,605 --> 00:44:09,609
SCARSY THINK AND THE FIBROSIS,

1155
00:44:09,609 --> 00:44:10,610
YEAH.

1156
00:44:10,610 --> 00:44:11,678
>> THANK YOU.

1157
00:44:11,678 --> 00:44:12,111
>> THANK YOU.

1158
00:44:12,111 --> 00:44:15,748
>> THANK YOU NOEL, THAT
WAS A

1159
00:44:15,748 --> 00:44:16,316
GREAT TALK.

1160
00:44:16,316 --> 00:44:18,851
I'M INTERESTED IN THE TYPE 2 MI.

1161
00:44:18,851 --> 00:44:22,989
SO IS FLOW REDUCED IN IS THERE

1162
00:44:22,989 --> 00:44:26,359
ANY--IS FLOW REDUCED IN THAT?

1163
00:44:26,359 --> 00:44:28,928
>> TYPE 2 MI, AGAIN,
DEFINED AT

1164
00:44:28,928 --> 00:44:30,196
A ROUGH PHENOTYPE IS YOU KNOW

1165
00:44:30,196 --> 00:44:32,332
THEY HAVE A RISE AND FALL OF THE

1166
00:44:32,332 --> 00:44:35,001
TRIPONIN SO IT'S NOT A CONSTANT

1167
00:44:35,001 --> 00:44:36,803
AND THAT, YOU KNOW THE

1168
00:44:36,803 --> 00:44:39,339
MECHANISTIC UNDERSTANDING IS

1169
00:44:39,339 --> 00:44:41,507
THAT THE DEMAND OUTSTRIPS THE

1170
00:44:41,507 --> 00:44:43,476
FLOW AND SO IT'S AN IMBALANCE SO

1171
00:44:43,476 --> 00:44:48,147
WHAT WOULD BE A COMMON TYPE 2

1172
00:44:48,147 --> 00:44:52,719
MI,EUR O ACCEPTIS, SO EXTREME

1173
00:44:52,719 --> 00:44:54,487
OXYGEN DEMAND, RIGHT?

1174
00:44:54,487 --> 00:44:57,657
YOU'RE IN SHOCK, EVERYBODY'S

1175
00:44:57,657 --> 00:44:58,992
STARVING NOBODY'S GETTING ENOUGH

1176
00:44:58,992 --> 00:45:01,694
OXYGEN SO AS MUCH AS THEY CAN

1177
00:45:01,694 --> 00:45:04,464
VASE O DILATE AND DELIVER THAT

1178
00:45:04,464 --> 00:45:05,865
OXYGEN, IT OUTSTRIPS SO THAT

1179
00:45:05,865 --> 00:45:07,367
WOULD BE 1 MECHANISM BUT WE ALSO

1180
00:45:07,367 --> 00:45:09,569
SEE TYPE 2 MIs WHERE THE

1181
00:45:09,569 --> 00:45:11,871
DEMAND DOESN'T LOOK THAT

1182
00:45:11,871 --> 00:45:12,272
STRESSFUL, RIGHT?

1183
00:45:12,272 --> 00:45:16,009
AND SO THEN WE WOULD HYPOTHESIZE

1184
00:45:16,009 --> 00:45:17,443
AND THIS IS WORK THAT NEEDS TO

1185
00:45:17,443 --> 00:45:20,146
BE DONE BECAUSE THE TYPE 2 MI

1186
00:45:20,146 --> 00:45:21,481
HAS ONLY RECENTLY BEEN TARTED.

1187
00:45:21,481 --> 00:45:22,548
YOU KNOW IT'S ANOTHER 1 OF

1188
00:45:22,548 --> 00:45:25,351
THESE, WE HAVE TO WAIT 10 YEARS

1189
00:45:25,351 --> 00:45:26,185
FOR THE EPIDEMIOLOGIST TO SAY,

1190
00:45:26,185 --> 00:45:28,621
WHOA THIS IS AN EPIDEMIC.

1191
00:45:28,621 --> 00:45:28,988
[LAUGHTER]

1192
00:45:28,988 --> 00:45:30,757
WE'RE HAVING AN EPIDIMMIC OF

1193
00:45:30,757 --> 00:45:33,493
TYPE 2 MIs, GO STUDY IT SM AND

1194
00:45:33,493 --> 00:45:35,928
SO HOW MANY OF THEM ARE GOING TO

1195
00:45:35,928 --> 00:45:39,165
BE IN THOSE DIFFERENT CAMPS,

1196
00:45:39,165 --> 00:45:41,134
SORRY, THEY TEND TO BE OLDER BUT

1197
00:45:41,134 --> 00:45:43,670
AGAIN, WE MAY BE MISSING TYPE 2

1198
00:45:43,670 --> 00:45:46,839
MIs IN WOMEN BECAUSE OF THE

1199
00:45:46,839 --> 00:45:48,508
MALE PATTERN TRIPONIN THRESHOLD.

1200
00:45:48,508 --> 00:45:50,810
>> AND I WONDER WHETHER
THERE'S

1201
00:45:50,810 --> 00:45:52,011
A METABOLIC COMPONENT TO IS.

1202
00:45:52,011 --> 00:45:52,979
THAT'S PART OF THE REASON.

1203
00:45:52,979 --> 00:45:54,280
IT WOULD BE INTERESTING TO LOOK

1204
00:45:54,280 --> 00:45:55,114
AT IT.

1205
00:45:55,114 --> 00:45:56,716
>> ABSOLUTELY COULD BE
BECAUSE

1206
00:45:56,716 --> 00:45:58,551
YOU KNOW, YOU WILL SEE 55

1207
00:45:58,551 --> 00:45:59,852
YEAR-OLD WOMEN, YOU KNOW THEY

1208
00:45:59,852 --> 00:46:02,355
HAVE THE SAME AGE, SAME RISK

1209
00:46:02,355 --> 00:46:04,691
FACTORS, THEY HAVE THE SAME

1210
00:46:04,691 --> 00:46:06,192
MENOPAUSAL STATUS AND YET 1 GETS

1211
00:46:06,192 --> 00:46:08,494
INTO TROUBLE WITH THIS FLOW

1212
00:46:08,494 --> 00:46:11,197
RESERVE, AND HAS INOCA AND MIGHT

1213
00:46:11,197 --> 00:46:13,566
BE MINOCA AND THE OTHER 1'S JUST

1214
00:46:13,566 --> 00:46:15,768
FINE, HYPER TENSIVE, SAME ISSUES

1215
00:46:15,768 --> 00:46:16,869
BUT SHE'S--SO I THINK THAT'S

1216
00:46:16,869 --> 00:46:19,572
EXACTLY RIGHT AND THE OMICs

1217
00:46:19,572 --> 00:46:22,442
MAY HELP US UNDERSTAND THAT.

1218
00:46:22,442 --> 00:46:23,276
>> YES, SIR.

1219
00:46:23,276 --> 00:46:24,977
>> YES, VERY NICE TALK,
QUESTION

1220
00:46:24,977 --> 00:46:30,116
IS HOW DOES LIPO TEEN DELAY

1221
00:46:30,116 --> 00:46:34,387
FACTOR IN YOUR POPULATION IN

1222
00:46:34,387 --> 00:46:36,723
WOMEN VERSUS MEN?

1223
00:46:36,723 --> 00:46:38,691
>> YEAH, GREAT QUESTION,
IF MY

1224
00:46:38,691 --> 00:46:39,659
COLLEAGUE WAS HERE, SHE WOULD

1225
00:46:39,659 --> 00:46:41,961
SAY THIS IS SUCH A BIG PROBLEM

1226
00:46:41,961 --> 00:46:43,162
AND THANK GOODNESS THESE TRUGS

1227
00:46:43,162 --> 00:46:45,198
ARE COMING SO I HAVE TO TELL YOU

1228
00:46:45,198 --> 00:46:48,301
THERE'S CONTROVERSY IN THE

1229
00:46:48,301 --> 00:46:50,269
FIELD, NOEL WHO WORKED WHEN THE

1230
00:46:50,269 --> 00:46:53,673
CDC WAS WORKING WITH THE

1231
00:46:53,673 --> 00:46:54,507
NATIONAL CHOLESTEROL EDUCATION

1232
00:46:54,507 --> 00:46:56,909
PROGRAM TO CERTIFY THE NATION'S

1233
00:46:56,909 --> 00:46:59,011
LABS FOR THAT STANDARD LIPID

1234
00:46:59,011 --> 00:47:01,714
PANEL BECAUSE YOU KNOW YOU BEING

1235
00:47:01,714 --> 00:47:02,782
SEND SPLIT SAMPLES TO 2

1236
00:47:02,782 --> 00:47:05,251
DIFFERENT LABS AND YOU WOULD GET

1237
00:47:05,251 --> 00:47:07,787
TOTALLY DIFFERENT RESULTS, AT

1238
00:47:07,787 --> 00:47:11,224
THIS TIME WITH GEORGE MENSA THE

1239
00:47:11,224 --> 00:47:14,560
LP LITTLE ASSAYS WERE UP FOR

1240
00:47:14,560 --> 00:47:15,194
ALSO STANDARDIZATION, LIKE

1241
00:47:15,194 --> 00:47:17,430
EVERYBODY HAD TO DO IT THE SAME

1242
00:47:17,430 --> 00:47:22,668
WAY AND IT FELL OFF THE RADAR

1243
00:47:22,668 --> 00:47:27,340
AND WAS NOT IMPLEMENTED, DITTO

1244
00:47:27,340 --> 00:47:28,174
HOMOCYSTINE, SAME THING,

1245
00:47:28,174 --> 00:47:30,877
HOMOCYSTINE IS A REAL PROBLEM

1246
00:47:30,877 --> 00:47:32,645
FOR LAB VARIABILITY, NOW THAT

1247
00:47:32,645 --> 00:47:34,414
THIS IS COMING OUT, FUTURE DRUGS

1248
00:47:34,414 --> 00:47:37,650
ARE IN PHASE 2, PHASE 32, IT'S

1249
00:47:37,650 --> 00:47:39,152
ANYTHING TO BE AN ISSUE AGAIN,

1250
00:47:39,152 --> 00:47:42,355
AND SO FAR, OF THE PEOPLE THAT

1251
00:47:42,355 --> 00:47:44,557
I'VE TALKED TO THAT NOBODY IS

1252
00:47:44,557 --> 00:47:47,427
SUGGESTING THIS, OR NO WORK IS

1253
00:47:47,427 --> 00:47:48,728
BEING DONE AT AUTHORITATIVE

1254
00:47:48,728 --> 00:47:53,599
LEVELS SO I WOULD BE A LITTLE

1255
00:47:53,599 --> 00:47:55,635
SKEPTICAL ABOUT WHOSE REALLY

1256
00:47:55,635 --> 00:47:56,068
HIGH.

1257
00:47:56,068 --> 00:47:57,470
THE OTHER THING THAT INDUSTRY IS

1258
00:47:57,470 --> 00:47:58,905
GOING TO WANT TO TELL US THESE

1259
00:47:58,905 --> 00:48:00,440
DRUGS AND THEY'RE GOING TO SAY,

1260
00:48:00,440 --> 00:48:01,908
OKAY, WELL EVEN THOUGH IT'S ONLY

1261
00:48:01,908 --> 00:48:05,611
1 IN A HUNDRED OR 1 IN 250 THAT

1262
00:48:05,611 --> 00:48:07,013
HAS A HIGH ENOUGH LEVEL THAT WE

1263
00:48:07,013 --> 00:48:09,048
WOULD ENROLL THEM IN A CLINICAL

1264
00:48:09,048 --> 00:48:09,849
TRIAL, THEY'RE GOING TO SAY,

1265
00:48:09,849 --> 00:48:12,819
IT'S GOING TO BE A CONTINUOUS

1266
00:48:12,819 --> 00:48:13,019
SCALE.

1267
00:48:13,019 --> 00:48:17,056
THESE ARE GOING TO BE REALLY

1268
00:48:17,056 --> 00:48:20,726
EXPENSIVE DRUGS AND I--I WOULD

1269
00:48:20,726 --> 00:48:23,062
BE CAUTIOUS ABOUT HOW MUCH THIS

1270
00:48:23,062 --> 00:48:23,963
WILL PLAY OUT.

1271
00:48:23,963 --> 00:48:26,332
HAPPY TO BE WRONG.

1272
00:48:26,332 --> 00:48:28,401
BUT I THINK SO MANY OF THESE

1273
00:48:28,401 --> 00:48:31,504
OTHER TARGETS ARE GOING TO NEED

1274
00:48:31,504 --> 00:48:34,507
A PRECISION MEDICINE DIAGNOSTIC

1275
00:48:34,507 --> 00:48:36,943
TO REALLY UNDERSTAND WHOSE AT

1276
00:48:36,943 --> 00:48:39,479
RISK AND WHOSE NOT FOR THE SUPER

1277
00:48:39,479 --> 00:48:40,546
EXPENSIVE DRUGS.

1278
00:48:40,546 --> 00:48:42,281
>> THANK YOU.

1279
00:48:42,281 --> 00:48:44,917
>> AND SUPER EXPENSIVE,
200,000,

1280
00:48:44,917 --> 00:48:47,487
250,000 A YEAR LIKE SOME OF

1281
00:48:47,487 --> 00:48:48,287
THESE ONCOLOGY DRUGS.

1282
00:48:48,287 --> 00:48:56,329
YEAH, THAT'S MY TAKE. 

1283
00:48:56,329 --> 00:48:58,197
>> DOCTOR, THANK YOU SO
MUCH FOR

1284
00:48:58,197 --> 00:49:00,800
A WONDERFUL TALK, WE KNOW THAT

1285
00:49:00,800 --> 00:49:01,501
HDL VARIES WHAT'S DIFFERENT

1286
00:49:01,501 --> 00:49:02,535
BETWEEN MEN AND WOMEN AND EVEN

1287
00:49:02,535 --> 00:49:05,538
IN WOMEN AT THE SAME TIME PREAND

1288
00:49:05,538 --> 00:49:07,740
POST MENOPAUSAL DUE TO ALSO

1289
00:49:07,740 --> 00:49:11,544
HORMONES, BUT HERE, MY QUESTION

1290
00:49:11,544 --> 00:49:14,747
IS, IN ANY OF YOUR STUDIES WAS

1291
00:49:14,747 --> 00:49:16,649
THERE ANY ASSOCIATION BETWEEN--I

1292
00:49:16,649 --> 00:49:19,519
KNOW THERE MAY NOT BE LIKE ANY

1293
00:49:19,519 --> 00:49:24,624
HDL FUNCTIONALITY TESTS BUT ON

1294
00:49:24,624 --> 00:49:34,800
THE HDL, IT'S HDL-C LEVELS IN

1295
00:49:34,800 --> 00:49:38,237
DEVELOPING IN OCA OR STEMI.

1296
00:49:38,237 --> 00:49:39,071
>> ANOTHER GOOD QUESTION
AND

1297
00:49:39,071 --> 00:49:41,374
ANOTHER AREA WHERE WE HAVE HDL

1298
00:49:41,374 --> 00:49:46,078
DRUGS THAT ARE NOT EXPENSIVE.

1299
00:49:46,078 --> 00:49:48,281
NIACIN IS A GREAT DRUG, HARD TO

1300
00:49:48,281 --> 00:49:50,783
TAKE BUT IT'S A GREAT DRUG AND

1301
00:49:50,783 --> 00:49:51,217
IT'S CHEAP.

1302
00:49:51,217 --> 00:49:52,818
IF YOU WERE A DESERT IESHES LAND

1303
00:49:52,818 --> 00:49:54,987
AND YOU COULD ONLY HAVE 1 DRUG,

1304
00:49:54,987 --> 00:49:57,490
YOU MIGHT WISH IT WAS NIACIN, SO

1305
00:49:57,490 --> 00:50:00,493
THERE'S BEEN A LOT OF WORK IN

1306
00:50:00,493 --> 00:50:01,894
HDECKER L, AND IT'S PRETTY MUCH

1307
00:50:01,894 --> 00:50:06,499
A BIG FAT NOTHING.

1308
00:50:06,499 --> 00:50:09,135
ALL OF THE HDL RAISING DRUGS

1309
00:50:09,135 --> 00:50:10,970
DON'T DO ANYTHING GOOD.

1310
00:50:10,970 --> 00:50:13,940
HDL FUNCTION IS VERY HARD TO

1311
00:50:13,940 --> 00:50:16,042
TEST SO THAT HAS NOT BEEN SCALED

1312
00:50:16,042 --> 00:50:17,810
UP TO CLINICAL TRIALS, IT HAS TO

1313
00:50:17,810 --> 00:50:20,112
BE DONE ON LIVE BLOOD, LIKE

1314
00:50:20,112 --> 00:50:20,880
PLATELET FUNCTION, SAME THING,

1315
00:50:20,880 --> 00:50:23,382
WE DON'T HAVE A LOT OF PLATELET

1316
00:50:23,382 --> 00:50:27,053
FUNCTION TESTS IN BIG CLINICAL

1317
00:50:27,053 --> 00:50:29,989
TRIALS, AND THEN, THE WORK THAT

1318
00:50:29,989 --> 00:50:35,061
WE HAVE DONE IN INOCA, MINOCA IS

1319
00:50:35,061 --> 00:50:37,029
A VERY WELL REPRODUCED J-SHAPED

1320
00:50:37,029 --> 00:50:37,396
CURVE.

1321
00:50:37,396 --> 00:50:43,002
SO THERE IS INCREASED

1322
00:50:43,002 --> 00:50:44,337
CARDIOVASCULAR MACE, MORBIDITY

1323
00:50:44,337 --> 00:50:48,741
AND DEATH AND VERY LOW HDL AND

1324
00:50:48,741 --> 00:50:49,642
VERY HIGH HDL.

1325
00:50:49,642 --> 00:50:51,711
AND THE THRESHOLDS FOR WOMEN ARE

1326
00:50:51,711 --> 00:50:53,980
UNDER 50 THAT WOULD BE

1327
00:50:53,980 --> 00:50:56,148
CONSIDERED LOW HDL, AND OVER 70

1328
00:50:56,148 --> 00:51:01,053
WHICH IS CONSIDERED HIGH HDL.

1329
00:51:01,053 --> 00:51:04,924
BUT IN DEVELOPING OBSTRUCTIVE OR

1330
00:51:04,924 --> 00:51:08,027
NONOBSTRUCTIVE MIs IS THERE A

1331
00:51:08,027 --> 00:51:10,229
DIFFERENCE IN HDLC LEVELS?

1332
00:51:10,229 --> 00:51:11,664
NTHAT WOULD BE A GOOD QUESTION.

1333
00:51:11,664 --> 00:51:13,265
WE COULD LOOK AT THAT BECAUSE WE

1334
00:51:13,265 --> 00:51:15,034
HAVE IN THE ORIGINAL WISE

1335
00:51:15,034 --> 00:51:16,335
COHORT, AGAIN BY DESIGN, BECAUSE

1336
00:51:16,335 --> 00:51:19,805
THEY WOULDN'T LET US HAVE MEN AS

1337
00:51:19,805 --> 00:51:20,973
CONTROLS, WE INCLUDED ABOUT A

1338
00:51:20,973 --> 00:51:22,608
THIRD OF THAT ORIGINAL COHORT

1339
00:51:22,608 --> 00:51:24,377
THAT DID HAVE OBLIGATIONS

1340
00:51:24,377 --> 00:51:25,645
TRUCTIVE CORONARY DEC, AND WE

1341
00:51:25,645 --> 00:51:26,946
HAVE THE LONG-TERM FOLLOW UP ON

1342
00:51:26,946 --> 00:51:31,283
THEM, SO I WILL HAVE MY FELLOW,

1343
00:51:31,283 --> 00:51:33,386
THAT'S DR. RON SINGA 1 OF OUR

1344
00:51:33,386 --> 00:51:38,124
CURRENT FELLOWS JUST PUBLISHED

1345
00:51:38,124 --> 00:51:41,327
IN THE AMERICAN JOURNAL

1346
00:51:41,327 --> 00:51:42,194
RJ-SHAPED CURVE, SOMETHING

1347
00:51:42,194 --> 00:51:43,796
THAT'S BEEN SEEN IN EPIDEMIOLOGY

1348
00:51:43,796 --> 00:51:45,331
IN GENERAL COHORTS ABOUT YOU

1349
00:51:45,331 --> 00:51:49,769
AGAIN WE HAVE THE INOCA, MINOCA

1350
00:51:49,769 --> 00:51:50,536
COHORT.

1351
00:51:50,536 --> 00:51:51,237
>> GOOD, THANK YOU.

1352
00:51:51,237 --> 00:51:55,574
NGREAT TALK EMPLOY I--

1353
00:51:55,574 --> 00:51:56,876
>> GREAT TALK.

1354
00:51:56,876 --> 00:51:59,845
I WAS WONDERING WITH OZEMPIC,

1355
00:51:59,845 --> 00:52:02,181
AND HAVE HAS AFFECTED YOUR

1356
00:52:02,181 --> 00:52:06,118
PATIENT COHORT AND INOCA AND

1357
00:52:06,118 --> 00:52:07,119
DEVELOPMENT OF ABNORMAL GLUCOSE

1358
00:52:07,119 --> 00:52:09,155
TOLERANCELER O SCLEROSIS IN

1359
00:52:09,155 --> 00:52:10,389
THESE PATIENTS?

1360
00:52:10,389 --> 00:52:11,057
>> GREAT QUESTION.

1361
00:52:11,057 --> 00:52:11,891
AND THERE'S 4 ON THE MARKET NOW

1362
00:52:11,891 --> 00:52:14,093
AND MORE TO COME, THERE'S

1363
00:52:14,093 --> 00:52:16,729
TREMENDOUS INTEREST AND

1364
00:52:16,729 --> 00:52:17,797
EXCITEMENT AND THEY'RE

1365
00:52:17,797 --> 00:52:19,298
ORIGINALLY DEVELOPED FOR

1366
00:52:19,298 --> 00:52:24,403
DIABETES, BUT BECAUSE THE FDA,

1367
00:52:24,403 --> 00:52:27,173
BECAUSE OF THE UREA PROBLEMS OF

1368
00:52:27,173 --> 00:52:28,074
CONTROLLING BLOOD SUGAR BUT OH

1369
00:52:28,074 --> 00:52:30,509
BY THE WAY KILLING THE PATIENT,

1370
00:52:30,509 --> 00:52:31,577
THEY REQUIRED THAT INDUSTRY

1371
00:52:31,577 --> 00:52:35,147
DEVELOP THESE DRUGS WITH VERY

1372
00:52:35,147 --> 00:52:35,614
CAREFUL CARDIOVASCULAR

1373
00:52:35,614 --> 00:52:38,350
MONITORING TO SHOW THAT IT WAS

1374
00:52:38,350 --> 00:52:40,853
SAFE AND LOW AND BEHOLD THESE

1375
00:52:40,853 --> 00:52:43,322
DRUGS AS WELL AS THE SGLT

1376
00:52:43,322 --> 00:52:46,759
INHIBITORS HAVE BEEN SHOWN TO BE

1377
00:52:46,759 --> 00:52:48,327
EFFECTIVE FOR REDUCING

1378
00:52:48,327 --> 00:52:49,595
CARDIOVASCULAR MORBIDITY AND

1379
00:52:49,595 --> 00:52:51,430
MORTALITY, NOT ONLY SAFE,

1380
00:52:51,430 --> 00:52:55,301
EFFECTIVE, AND THEY'RE

1381
00:52:55,301 --> 00:52:57,937
INCREASINGLY GETTING APPROVED

1382
00:52:57,937 --> 00:52:58,904
FOR THAT INDICATION.

1383
00:52:58,904 --> 00:53:02,007
SO THESE DIABETES DRUGS AND IT

1384
00:53:02,007 --> 00:53:05,211
WAS KNOWN, I MEAN IT'S A KNOWN

1385
00:53:05,211 --> 00:53:06,712
MECHANISM RIGHT OF INTERFERING

1386
00:53:06,712 --> 00:53:09,248
WITH THE GHASTIC HORMONE PROCESS

1387
00:53:09,248 --> 00:53:11,884
THAT PEOPLE LITE LESS, THERE'S

1388
00:53:11,884 --> 00:53:13,385
NOTHING MAGIC ABOUT THESE DRUGS

1389
00:53:13,385 --> 00:53:17,556
THEY JUST GET PEOPLE TO EAT LESS

1390
00:53:17,556 --> 00:53:18,991
SO I'VE HAD THESE ARGUE AMS WITH

1391
00:53:18,991 --> 00:53:20,659
PATIENTS, IT'S JUST THE SAME AS

1392
00:53:20,659 --> 00:53:25,231
EATING LESS, NO IT'S NOT, IT'S A

1393
00:53:25,231 --> 00:53:25,464
MIRACLE.

1394
00:53:25,464 --> 00:53:28,534
I'VE STRUGGLED MY WHOLE LIFE AND

1395
00:53:28,534 --> 00:53:31,003
I EAT NOTHING SO THAT'S THE

1396
00:53:31,003 --> 00:53:32,738
CLASS OF DRUGS THAT HE'S ASKING

1397
00:53:32,738 --> 00:53:37,443
ABOUT AND WHEN WE LOOK AT OUR

1398
00:53:37,443 --> 00:53:41,046
INOCA, MINOCA POPULATION, THEY

1399
00:53:41,046 --> 00:53:42,448
LOOK JUST LIKE AMERICA SO HALF

1400
00:53:42,448 --> 00:53:45,184
OF THEM ARE OVERWEIGHT AND A

1401
00:53:45,184 --> 00:53:47,119
SMALLER PERCENT ARE OBESE, SO

1402
00:53:47,119 --> 00:53:49,789
ABOUT 60% OF OUR PATIENTS JUST

1403
00:53:49,789 --> 00:53:53,859
LIKE AMERICANS ARE EITHER

1404
00:53:53,859 --> 00:53:57,263
OVERWEIGHT OR OBESE AND THEY

1405
00:53:57,263 --> 00:54:00,533
WANT THESE DRUGS, DR. MATHA

1406
00:54:00,533 --> 00:54:06,705
GULATI IS OUR PREVENTIVE

1407
00:54:06,705 --> 00:54:07,840
SPECIALIST, I'M MORE LIKE SHOW

1408
00:54:07,840 --> 00:54:08,507
ME THE DATA.

1409
00:54:08,507 --> 00:54:11,410
SO HERE'S THE DATA SO FAR, THESE

1410
00:54:11,410 --> 00:54:14,280
WERE APPROVED AND BEEN AVAILABLE

1411
00:54:14,280 --> 00:54:15,080
FOR ABOUT 2 YEARS.

1412
00:54:15,080 --> 00:54:18,184
AT THE END OF 1 YEAR, 26% OF

1413
00:54:18,184 --> 00:54:21,253
PATIENTS ARE STILL TAKING IT.

1414
00:54:21,253 --> 00:54:24,390
WHEN YOU STOP TAKING IT, THE

1415
00:54:24,390 --> 00:54:27,026
VAST MAIORITY OF PATIENTS REGAIN

1416
00:54:27,026 --> 00:54:31,530
THE WEIGHT, WE'VE HAD A LOT OF

1417
00:54:31,530 --> 00:54:33,799
PROBLEMS WITH WORSENING

1418
00:54:33,799 --> 00:54:35,267
INSURANCE COVERAGE AS THIS

1419
00:54:35,267 --> 00:54:39,572
MARKET HAS JUST EXPLODED.

1420
00:54:39,572 --> 00:54:41,640
AND SO FOR EXAMPLE, MEDICARE IF

1421
00:54:41,640 --> 00:54:43,375
YOU TALK ABOUT CARDIOVASCULAR

1422
00:54:43,375 --> 00:54:45,244
DEC, THE MAIORITY OF PATIENTS

1423
00:54:45,244 --> 00:54:48,080
WILL BE MEDICARE AGE, YOU HAVE

1424
00:54:48,080 --> 00:54:49,248
TO MEET CRITERIA BUT THEN YOU

1425
00:54:49,248 --> 00:54:51,684
GET FUNDED AND THAT MIGHT BE THE

1426
00:54:51,684 --> 00:54:53,719
26% THAT ACTUALLY GET IT

1427
00:54:53,719 --> 00:54:56,622
COVERED, A LOT OF THE INDEMNITY

1428
00:54:56,622 --> 00:55:07,233
INSURANCE, YOU KNOW, I HAD 1

1429
00:55:07,233 --> 00:55:08,767
PATIENT, DIABETIC, A1C

1430
00:55:08,767 --> 00:55:10,269
STABILIZED, LOST WEIGHT AND THE

1431
00:55:10,269 --> 00:55:12,972
DRUG COMPANY SAYS WE WON'T PAY

1432
00:55:12,972 --> 00:55:15,407
FOR IT ANYMORE BECAUSE YOU'RE

1433
00:55:15,407 --> 00:55:15,808
DIABETIC.

1434
00:55:15,808 --> 00:55:17,810
AND THE LAST REASON THAT I'M

1435
00:55:17,810 --> 00:55:20,546
MORE LIKE SHOW ME THE LONG-TERM

1436
00:55:20,546 --> 00:55:22,481
DATA BECAUSE OVERWEIGHT AND

1437
00:55:22,481 --> 00:55:23,782
OBESITY IS A CHRONIC ILLNESS,

1438
00:55:23,782 --> 00:55:26,352
WHAT HAPPENS WHEN YOU LOSE

1439
00:55:26,352 --> 00:55:28,988
WEIGHT, LET'S SAY YOU LOST

1440
00:55:28,988 --> 00:55:29,922
10-POUNDS, YOU LOST 6-POUNDS OF

1441
00:55:29,922 --> 00:55:32,124
FAT BUT YOU LOST 4-POUNDS OF

1442
00:55:32,124 --> 00:55:33,659
MUSCLE AND BONE AND WHAT DOES

1443
00:55:33,659 --> 00:55:35,494
THE AVERAGE ADULT DO WHEN THEY

1444
00:55:35,494 --> 00:55:38,230
REGAIN WEIGHT, DO THEY GO TO THE

1445
00:55:38,230 --> 00:55:40,833
GYM AND EXERCISE AND DO WEIGHT

1446
00:55:40,833 --> 00:55:41,500
TRAINING AND AEROBIC?

1447
00:55:41,500 --> 00:55:42,434
NO.

1448
00:55:42,434 --> 00:55:44,069
SO WHEN THEY REGAIN THE WEIGHT,

1449
00:55:44,069 --> 00:55:45,971
THIS AGAIN IS WELL DOCUMENTED,

1450
00:55:45,971 --> 00:55:50,709
IT'S ALMOST ALL FAT, SO, THIS

1451
00:55:50,709 --> 00:55:53,512
WEIGHT CYCLING POTENTIALLY WILL

1452
00:55:53,512 --> 00:55:56,048
CONTRIBUTE TO FRAILTY AND

1453
00:55:56,048 --> 00:55:59,151
INCREASED AGING SO,--AND THERE

1454
00:55:59,151 --> 00:56:00,786
ARE NO GUIDELINES YET, THERE'S

1455
00:56:00,786 --> 00:56:04,657
NO DATA ABOUT THE RUNWAY.

1456
00:56:04,657 --> 00:56:06,759
LIKE, HOW LONG CAN YOU TAKE

1457
00:56:06,759 --> 00:56:08,060
THESE DRUGS, WHAT HAPPENS WHEN

1458
00:56:08,060 --> 00:56:09,028
YOU WEIGHT CYCLE, WHAT HAPPENS

1459
00:56:09,028 --> 00:56:12,898
WHEN YOU HIT YOUR GOAL WEIGHT?

1460
00:56:12,898 --> 00:56:13,632
THEY'RE TRYING TO--THEY'RE

1461
00:56:13,632 --> 00:56:17,136
WORKING RIGHT NOW TO GET THE

1462
00:56:17,136 --> 00:56:19,104
SEMIGLUE TIDE ORAL AND THAT

1463
00:56:19,104 --> 00:56:25,144
MIGHT BE AN OFFRAMP, MIGHT, SO

1464
00:56:25,144 --> 00:56:25,911
I'M--I'M EXPRESSING SOME CONCERN

1465
00:56:25,911 --> 00:56:27,680
EXCEPT FOR MY HIGH RISK PATIENTS

1466
00:56:27,680 --> 00:56:30,249
AND THEN I SEND THEM TO

1467
00:56:30,249 --> 00:56:34,553
DR. GULATI, BECAUSE SHE LIKES

1468
00:56:34,553 --> 00:56:37,156
BATTLING WITH THE INNERSURANCE

1469
00:56:37,156 --> 00:56:37,790
COMPANIES.

1470
00:56:37,790 --> 00:56:38,290
>> THANK YOU.

1471
00:56:38,290 --> 00:56:40,459
>> WONDERFUL TALK, SO DVT
IS A

1472
00:56:40,459 --> 00:56:42,761
WELL KNOWN SIDE EFFECT OF ORAL

1473
00:56:42,761 --> 00:56:45,197
CONTRACEPTIVES AND I WAS

1474
00:56:45,197 --> 00:56:46,699
WONDERING IF IN PREMENOPAUSAL

1475
00:56:46,699 --> 00:56:50,736
WOMEN IN YOUR STUDY IF YOU FOUND

1476
00:56:50,736 --> 00:56:51,904
ASSOCIATIONS BETWEEN INCREASED

1477
00:56:51,904 --> 00:56:52,538
MICROVASCULAR COMPLICATIONS AND

1478
00:56:52,538 --> 00:56:55,607
THEIR AT THAT TIMEUS ON ORAL

1479
00:56:55,607 --> 00:56:55,975
CONTRACEPTIVES.

1480
00:56:55,975 --> 00:57:00,679
>> GOOD QUESTION.

1481
00:57:00,679 --> 00:57:02,614
SO, WE DID A WHOLE LINE AGAIN

1482
00:57:02,614 --> 00:57:04,550
OBSERVATION BUT LOOKING FOR

1483
00:57:04,550 --> 00:57:06,719
MECHANISMS TO TRY TO UNDERSTAND

1484
00:57:06,719 --> 00:57:08,921
HOW MUCH ENDOGENOUS HORMONES AS

1485
00:57:08,921 --> 00:57:10,556
WELL AS EXOGENOUS WHICH WOULD BE

1486
00:57:10,556 --> 00:57:14,927
THE BIRTH CONTROL PILLS AND WE

1487
00:57:14,927 --> 00:57:18,530
BASICALLY DIDN'T FIND VERY MUCH

1488
00:57:18,530 --> 00:57:21,633
IN TERMS OF EXOGENOUS HORMONES

1489
00:57:21,633 --> 00:57:23,736
RISK OR BENEFIT, THESE ARE CROSS

1490
00:57:23,736 --> 00:57:24,636
SECTIONAL AND PERSPECTIVE

1491
00:57:24,636 --> 00:57:26,672
ANALYSIS, THEY'RE NOT THE SAME

1492
00:57:26,672 --> 00:57:29,074
AS RANDOMIZED CONTROLLED TRIALS

1493
00:57:29,074 --> 00:57:31,043
BUT, I WOULD--MY TAKE HOME WOULD

1494
00:57:31,043 --> 00:57:33,112
BE, IT LOOKED LIKE THE BIRTH

1495
00:57:33,112 --> 00:57:34,947
CONTROL PILLS WERE PROBABLY

1496
00:57:34,947 --> 00:57:38,450
RELATIVELY SAFE IN THESE INOCA,

1497
00:57:38,450 --> 00:57:40,085
AND MINOCA PATIENTS, I'M NOT

1498
00:57:40,085 --> 00:57:41,487
SAYING I WOULD PRESCRIBE THEM

1499
00:57:41,487 --> 00:57:43,522
BUT WE DID SEE EVIDENCE OF

1500
00:57:43,522 --> 00:57:44,957
SERIOUS HARM IN A THOUSAND

1501
00:57:44,957 --> 00:57:47,426
PATIENTS FOLLOWED NOW FOR 20

1502
00:57:47,426 --> 00:57:51,797
YEARS BUT ONLY PROBABLY 30%, 40%

1503
00:57:51,797 --> 00:57:53,265
WERE PREMENOPAUSAL AND HOW MANY

1504
00:57:53,265 --> 00:57:54,833
WERE TAKING THE BIRTH CONTROL

1505
00:57:54,833 --> 00:57:57,469
PILLS, I WOULD HAVE TO LOOK IT

1506
00:57:57,469 --> 00:57:57,636
UP.

1507
00:57:57,636 --> 00:57:58,804
SO I'M NOT SURE THAT WOULD BE

1508
00:57:58,804 --> 00:58:00,639
ENOUGH TO SAY THESE ARE SUPER

1509
00:58:00,639 --> 00:58:05,978
SAFE TO USE, WHAT WE DID FIND IN

1510
00:58:05,978 --> 00:58:07,179
ENDOGENOUS HORMONES IS VERY HIGH

1511
00:58:07,179 --> 00:58:11,884
PREVALENCE OF WHAT WE NOW CALL

1512
00:58:11,884 --> 00:58:12,384
HYPOTHALAMIC, HYPOESTRO

1513
00:58:12,384 --> 00:58:13,519
GENERATEDEMMIA AND THESE ARE

1514
00:58:13,519 --> 00:58:14,820
YOUNGER WOMEN, PREMOAN O PAUSAL

1515
00:58:14,820 --> 00:58:18,123
WOMEN UNDER THE AGE OF 50, AND

1516
00:58:18,123 --> 00:58:20,959
THEY TYPICALLY WILL SAY THEY

1517
00:58:20,959 --> 00:58:22,594
HAVE MENSTRUAL CYCLES BUT IF YOU

1518
00:58:22,594 --> 00:58:24,363
ACTUALLY HAVE THEM TRACK THEM,

1519
00:58:24,363 --> 00:58:27,866
WITH AN APP, THEY HAVE A LOT OF

1520
00:58:27,866 --> 00:58:29,101
MISSED PERIODS, THEY

1521
00:58:29,101 --> 00:58:30,269
PROBABLY--THEY ARE HAVING BREAK

1522
00:58:30,269 --> 00:58:34,339
THROUGH PLEADING, RATHER THAN

1523
00:58:34,339 --> 00:58:36,542
NICE REGULAR OVULEATORY CYCLES

1524
00:58:36,542 --> 00:58:39,378
AND THIS WAS ASSOCIATE WIDE

1525
00:58:39,378 --> 00:58:40,979
ACCELERATED ABNORMAL GLUCOSE

1526
00:58:40,979 --> 00:58:43,615
TOLERANCELER O SCLEROSIS.

1527
00:58:43,615 --> 00:58:46,018
WHO WAS HYPOTHALAMIC OR HYPO,

1528
00:58:46,018 --> 00:58:50,622
SOME OF THEM ARE AMENERRYIC, I

1529
00:58:50,622 --> 00:58:52,224
CAN'T TALK TODAY, THEY ARE MORE

1530
00:58:52,224 --> 00:58:57,262
LIKELY TO BE STRESSED, MORE

1531
00:58:57,262 --> 00:59:02,067
LIKELY TO DIABETIC, ATHLETES,

1532
00:59:02,067 --> 00:59:03,869
HIGH INTENSITY ATHLETES, VERY

1533
00:59:03,869 --> 00:59:04,903
LEAN, SOME EATING DISORDERS, AND

1534
00:59:04,903 --> 00:59:06,472
WE DID FIEND THAT IN OUR

1535
00:59:06,472 --> 00:59:09,341
ESTIMATION, THIS IS WORKING WITH

1536
00:59:09,341 --> 00:59:11,443
DR. SANDERS WHO IS NOW AT MAYO,

1537
00:59:11,443 --> 00:59:17,149
THIS IS PROBABLY BIGGER THAN PC

1538
00:59:17,149 --> 00:59:19,118
OS THIS HYPOTHALAMIC AMENERRIA.

1539
00:59:19,118 --> 00:59:20,219
DID I ANSWER YOUR QUESTION

1540
00:59:20,219 --> 00:59:21,019
EMPLOY.

1541
00:59:21,019 --> 00:59:21,687
>> THAT WAS PERFECT.

1542
00:59:21,687 --> 00:59:23,188
THANK YOU SO MUCH.

1543
00:59:23,188 --> 00:59:26,091
>> OKAY OKAY, THANK YOU
EMPLOY.

1544
00:59:26,091 --> 00:59:29,695
>> OKAY, HI, THANK YOU SO
UPON

1545
00:59:29,695 --> 00:59:30,062
FOR YOUR TALK.

1546
00:59:30,062 --> 00:59:32,998
SOMETHING I WAS WONDERING IS

1547
00:59:32,998 --> 00:59:36,301
WOULD YOU EXPECT SOMEONE WHO'S

1548
00:59:36,301 --> 00:59:38,370
TRANSGENDER WOMAN, SOMEONE WHO'S

1549
00:59:38,370 --> 00:59:39,371
BEEN TAKING ESTRO GENERATED

1550
00:59:39,371 --> 00:59:40,672
THERAPY FOR A LONG TIME AT LEAST

1551
00:59:40,672 --> 00:59:44,977
5 YEARS TO HAVE THE SAME I GUESS

1552
00:59:44,977 --> 00:59:46,812
PROPENSITY TOWARDS THE

1553
00:59:46,812 --> 00:59:47,813
NONOBSTRUCTIVE MIS, OR DO YOU

1554
00:59:47,813 --> 00:59:49,715
THINK THAT THERE'S MORE TO IT

1555
00:59:49,715 --> 00:59:51,950
THAN JUST LIKE ESTROIEN SORE

1556
00:59:51,950 --> 00:59:53,552
TESTOSTERONE BEING IN THE BLOOD

1557
00:59:53,552 --> 00:59:53,785
STREAM.

1558
00:59:53,785 --> 00:59:57,689
>> THIS IS A GOOD QUESTION
AND I

1559
00:59:57,689 --> 01:00:00,526
ACTUALLY HAVE DATA TO ANSWER

1560
01:00:00,526 --> 01:00:01,226
THAT.

1561
01:00:01,226 --> 01:00:02,494
WE WERE INTERESTED AGAIN EARLY

1562
01:00:02,494 --> 01:00:06,198
ON TO TRY TO UNDERSTAND THESE

1563
01:00:06,198 --> 01:00:07,633
REPRODUCTIVE HORMONES, RIGHT

1564
01:00:07,633 --> 01:00:08,901
BECAUSE THAT--IT MAKES INTUITIVE

1565
01:00:08,901 --> 01:00:10,102
SENSE, WHAT ARE BASIC SEX

1566
01:00:10,102 --> 01:00:11,503
DIFFERENCES IF YOU WERE GOING TO

1567
01:00:11,503 --> 01:00:13,839
STUDY WOMEN, YOU WOULD STUDY

1568
01:00:13,839 --> 01:00:14,673
THESE REPRODUCTIVE HORMONES SO

1569
01:00:14,673 --> 01:00:18,043
WE HAD AN EXPERIMENT, SORT OF

1570
01:00:18,043 --> 01:00:20,179
NATURE BECAUSE I HAD WORKED A

1571
01:00:20,179 --> 01:00:22,181
BIT WITH ERIC [INDISCERNIBLE] AT

1572
01:00:22,181 --> 01:00:25,184
UCLA AND HE HAD A COHORT OF

1573
01:00:25,184 --> 01:00:26,685
TRANSGENDER WOMEN, MEN WHO HAD

1574
01:00:26,685 --> 01:00:27,853
TRANSITIONED TO BEING WOMEN AND

1575
01:00:27,853 --> 01:00:29,755
THEY HAD ALL AGREED TO RESEARCH

1576
01:00:29,755 --> 01:00:31,523
AND HE ALREADY HAD THEM IN A

1577
01:00:31,523 --> 01:00:35,594
COHORT STUDY, AND WE WANTED TO

1578
01:00:35,594 --> 01:00:37,429
UNDERSTAND THE DATA FROM DENMARK

1579
01:00:37,429 --> 01:00:42,201
THAT BECAUSE THEY HAD BEEN DOING

1580
01:00:42,201 --> 01:00:43,936
TRANSGENDER HEALTHCARE, HELPING

1581
01:00:43,936 --> 01:00:45,370
ALLOWING PEOPLE TO TRANSITION

1582
01:00:45,370 --> 01:00:47,272
FOR OVER 50 YEARS AND THEY HAD

1583
01:00:47,272 --> 01:00:49,541
LONG-TERM FOLLOW UP STUDIES

1584
01:00:49,541 --> 01:00:53,078
WHERE THE TRANSGENDER WOMEN HAD

1585
01:00:53,078 --> 01:00:54,446
ACCELERATED CARDIOVASCULAR

1586
01:00:54,446 --> 01:00:56,515
DISEASE WERE DYING PREMATURELY

1587
01:00:56,515 --> 01:00:57,583
WHERE THE TRANSGENDER MEN WERE

1588
01:00:57,583 --> 01:01:00,018
NOT, SO THAT WAS AN IMPORTANT

1589
01:01:00,018 --> 01:01:01,520
SEX DIFFERENCE, RIGHT AND THE

1590
01:01:01,520 --> 01:01:04,056
RECORDS WERE PRETTY GOOD, IT

1591
01:01:04,056 --> 01:01:05,457
SEEMED REASONABLY BELIEVABLE.

1592
01:01:05,457 --> 01:01:13,732
AND SO, WE INVITED ERIC'S COHORT

1593
01:01:13,732 --> 01:01:16,168
TO COME AND DO--YOU KNOW WE DID

1594
01:01:16,168 --> 01:01:18,704
DEEP FINE O TYPING AND WE DID

1595
01:01:18,704 --> 01:01:20,706
CARDIAC MRI AND AGAIN WE WERE

1596
01:01:20,706 --> 01:01:22,774
PRETTY INTERESTED IN THIS

1597
01:01:22,774 --> 01:01:23,575
MYOCARDIAL TRIGLYCERIDE AS WELL

1598
01:01:23,575 --> 01:01:25,477
AS ALL THE OTHER THINGS WE DO

1599
01:01:25,477 --> 01:01:26,545
WITH MRIs AND THE THEN THE

1600
01:01:26,545 --> 01:01:28,180
LAST THING WE DID WAS WE KEPT

1601
01:01:28,180 --> 01:01:30,115
GOING TO JUST ABOVE THE KNEE CAP

1602
01:01:30,115 --> 01:01:32,551
SO WE COULD SAY THAT THEY

1603
01:01:32,551 --> 01:01:34,519
DID--THEY HAD OR HAD NOT

1604
01:01:34,519 --> 01:01:35,420
RETAINED THEIR TESTICLES, RIGHT?

1605
01:01:35,420 --> 01:01:41,693
AND WE ALSO DID COMPLETE

1606
01:01:41,693 --> 01:01:42,294
HORMONAL PROFILES.

1607
01:01:42,294 --> 01:01:43,562
AND THE VAST MAJORITY OF THEM

1608
01:01:43,562 --> 01:01:45,097
HAD NOT ONLY FATTY LIVER WHICH

1609
01:01:45,097 --> 01:01:48,233
WAS KNOWN, THEY HAD FATTY HEART,

1610
01:01:48,233 --> 01:01:50,068
THEY HAD PREMATURE CORONARY

1611
01:01:50,068 --> 01:01:51,036
ABNORMAL GLUCOSE TOLERANCELER O

1612
01:01:51,036 --> 01:01:52,671
SCLEROSIS AND THEY WERE INSULIN

1613
01:01:52,671 --> 01:01:55,974
RESISTANT AND THEN WHAT RELATED

1614
01:01:55,974 --> 01:01:57,843
ON IT A LOT OF THIS WAS THE

1615
01:01:57,843 --> 01:01:59,478
CROSS TALK BETWEEN THEIR

1616
01:01:59,478 --> 01:02:00,912
ESTROIEN AND THEIR ANDROGENS AND

1617
01:02:00,912 --> 01:02:02,748
THOSE THAT HAD RETAINED THEIR

1618
01:02:02,748 --> 01:02:10,689
TESTICLES HAD A LOT MORE OF THIS

1619
01:02:10,689 --> 01:02:11,390
DISMETABOLICKISM, RIGHT?

1620
01:02:11,390 --> 01:02:12,424
SO WE PUBLISHED THAT.

1621
01:02:12,424 --> 01:02:14,993
WE TRIED TO GET AN RO-1 FUNDED

1622
01:02:14,993 --> 01:02:19,598
AT THE TIME WAS IN THE BUSH

1623
01:02:19,598 --> 01:02:20,265
ADMINITRATION, WASN'T

1624
01:02:20,265 --> 01:02:21,300
POLITICALLY CORRECT.

1625
01:02:21,300 --> 01:02:22,067
DOES THAT HELP?

1626
01:02:22,067 --> 01:02:24,736
>> YEAH, THANK YOU SO
MUCH.

1627
01:02:24,736 --> 01:02:26,038
>> OKAY, VERY GOOD.

1628
01:02:26,038 --> 01:02:26,872
>> LOTS OF QUESTIONS
ONLINE BUT

1629
01:02:26,872 --> 01:02:28,507
YOU COVERED A LOT YOU MAYBE 1

1630
01:02:28,507 --> 01:02:30,642
TOPIC WE HAVEN'T TOUCHED ON, HOW

1631
01:02:30,642 --> 01:02:32,144
DOES PREGNANCY AFFECT LONG-TERM

1632
01:02:32,144 --> 01:02:33,945
HEALTH IN YOUR STUDY, WERE YOU

1633
01:02:33,945 --> 01:02:36,715
ABLE TO COMPARE WOMEN WITH

1634
01:02:36,715 --> 01:02:38,717
PREGNANCIES AND WOMEN WITHOUT

1635
01:02:38,717 --> 01:02:39,017
PREGNANCIES?

1636
01:02:39,017 --> 01:02:40,252
>> YES, WE HAVE LOOKEDDA
THE

1637
01:02:40,252 --> 01:02:43,355
THAT AS WELL AND WE REPLICATED

1638
01:02:43,355 --> 01:02:46,291
WHAT'S PRETTY WELL OBSERVED IS

1639
01:02:46,291 --> 01:02:49,227
WOMEN THAT HAVE NO CHILDREN AND

1640
01:02:49,227 --> 01:02:51,496
I'M NOT SAYING THIS IS YOU KNOW

1641
01:02:51,496 --> 01:02:53,465
A POLITICAL STATEMENT BUT THEY

1642
01:02:53,465 --> 01:02:55,400
TEND TO HAVE NOT AS GOOD HEALTH

1643
01:02:55,400 --> 01:02:59,071
AS WOMEN THAT HAVE AT LEAST 1

1644
01:02:59,071 --> 01:03:00,339
CHILD, THAT J-SHIP CURVE HAS

1645
01:03:00,339 --> 01:03:04,176
ALWAYS BEEN TRUE AND THEN AFTER

1646
01:03:04,176 --> 01:03:06,445
ABOUT 4 OR 5 CHILDREN HEALTH

1647
01:03:06,445 --> 01:03:11,316
BECOMES PREMATURE HEALTH IS A

1648
01:03:11,316 --> 01:03:11,550
PROBLEM.

1649
01:03:11,550 --> 01:03:14,753
WE DON'T KNOW BECAUSE OUR WISE

1650
01:03:14,753 --> 01:03:16,455
WOMEN, AGAIN RECRUITED INTO--BY

1651
01:03:16,455 --> 01:03:18,890
THE 1980S AND EARLY 90S, THEY

1652
01:03:18,890 --> 01:03:22,094
WERE JUST AT THE TIP OF THE

1653
01:03:22,094 --> 01:03:23,395
1960S ORAL CONTRACEPTION AND

1654
01:03:23,395 --> 01:03:25,964
WOMEN FINALLY BEING ABLE TO

1655
01:03:25,964 --> 01:03:29,601
SELF-MANAGE THEIR OWN FERTILITY

1656
01:03:29,601 --> 01:03:31,870
RATE, SO, IT'S A CHALLENGE TO

1657
01:03:31,870 --> 01:03:33,305
THE NEXT GENERATION TO STUDY

1658
01:03:33,305 --> 01:03:34,706
COHORTS AND NOT THE WOMEN'S

1659
01:03:34,706 --> 01:03:35,874
HEALTH BECAUSE THEY'RE THE SAME

1660
01:03:35,874 --> 01:03:39,077
AS OURS, AND NOT THE WOMEN'S

1661
01:03:39,077 --> 01:03:40,946
STUDY, THE JOANNE MANSON,

1662
01:03:40,946 --> 01:03:42,214
SOMEBODY'S GOT TO DO A BIG

1663
01:03:42,214 --> 01:03:43,749
STUDY, WE ARE SORT OF DOING THIS

1664
01:03:43,749 --> 01:03:47,686
WITH THE NEW MOM TO BE, ANOTHER

1665
01:03:47,686 --> 01:03:48,987
BIG NHLBI SPONSORED STUDY, BUT

1666
01:03:48,987 --> 01:03:50,722
THE POINT IS WHEN WOMEN CHOOSE

1667
01:03:50,722 --> 01:03:51,890
NOT TO HAVE CHILDREN, THAT'S

1668
01:03:51,890 --> 01:03:54,526
PROBABLY DIFFERENT FROM WOMEN

1669
01:03:54,526 --> 01:03:55,994
THAT ARE INFERTILE.

1670
01:03:55,994 --> 01:03:57,729
AND BECAUSE FERTILITY ONCE AGAIN

1671
01:03:57,729 --> 01:04:00,265
IS A WHOLISTIC HELT PREDICTER

1672
01:04:00,265 --> 01:04:01,867
AND THEN YOU MIGHT ASK WHY WHEN

1673
01:04:01,867 --> 01:04:07,205
YOU  GET MORE THAN 4.5 CHILDREN

1674
01:04:07,205 --> 01:04:09,474
PER WOMAN AND THAT WAS THE

1675
01:04:09,474 --> 01:04:12,210
ELIZABETH CONNOR THE PIZZA

1676
01:04:12,210 --> 01:04:12,511
HYPOTHESIS.

1677
01:04:12,511 --> 01:04:14,112
THAT AS SOON AS YOU HAVE MORE

1678
01:04:14,112 --> 01:04:15,313
THAN 4 CHILDREN, YOU JUST EAT

1679
01:04:15,313 --> 01:04:18,150
PIZZA ALL THE TIME.

1680
01:04:18,150 --> 01:04:19,017
[LAUGHTER]

1681
01:04:19,017 --> 01:04:19,951
ALL RIGHT, YEAH.

1682
01:04:19,951 --> 01:04:25,624
THANK YOU.

1683
01:04:25,624 --> 01:04:28,460
[ APPLAUSE ]

1684
01:04:28,460 --> 01:04:29,594
>> THANK YOU VERY MUCH FOR
THAT

1685
01:04:29,594 --> 01:04:31,830
WONDERFUL TALK AND THERE ARE

1686
01:04:31,830 --> 01:04:32,864
SOME REFRESHMENTS OUTSIDE SO WE

1687
01:04:32,864 --> 01:04:34,566
SHOULD JOIN THEM AND ALSO WANT

1688
01:04:34,566 --> 01:04:35,434
TO--WE'RE FOCUS ON THE

1689
01:04:35,434 --> 01:04:37,736
PRESENTING THE PLAQUE BUT I WANT

1690
01:04:37,736 --> 01:04:38,703
TO ACKNOWLEDGE THIS NICE PLAQUE

1691
01:04:38,703 --> 01:04:41,006
THAT WE WILL BE SENT TO YOU.

1692
01:04:41,006 --> 01:04:42,307
AND THANK YOU ALL FOR COME

1693
01:04:42,307 --> 01:04:44,609
NOTHING PERSON, THIS IS

1694
01:04:44,609 --> 01:04:45,677
WONDERFUL AND ENJOY, ENJOY

1695
01:04:45,677 --> 01:04:48,480
COOKIES OR FRUIT OR SOMETHING

1696
01:04:48,480 --> 01:04:58,657
OUTSIDE.