ELIZABETH ODILILE OFILI: Good morning.

GROUP: Good morning.

ELIZABETH ODILILE OFILI: What Dee didn't tell you was that she cracks a very tough whip. So Dr. Wenger and I were actually at an international meeting for the last two weeks in July, and I get back to the office and there's a message, "Dee wants you in Washington for a women's conference." I says, "Okay. It's Dee. Let's go." But it's really in appreciation of the type of work that she has done in the state of Georgia, and obviously now benefiting other parts of the country in congratulating she and other conference planners for this meeting. And again, it's in recognition of that that I am able to drop things with a busy schedule to be here. And I'm certainly very happy to be here and see the very bright faces. And I can't see the slide real well, so I can't put up my first slide. So somebody better come up and punch the slide play because I'm going to run out of things to say shortly. I just need the slide show. I was just joking with my colleagues that I hope that the screen is big enough because I left my glasses somewhere in Georgia. This should be very interesting.

I'm going to start with a story, and I think you heard a version of it. I was struck by how this story supports the notion that women in general are always busy taking care of everybody else. And I think some of the issues that we're going to have to recognize, particularly as we deal with the differences among ethnic minorities, is recognize the burden in terms of the family, and while that is not always a burden, what women are going to have to do in terms of taking charge for themselves. So this woman and her husband, the husband had crushing chest pain, and she had to rush him to the emergency room. And everybody was really fussing appropriately, because that's a major sign of a heart attack, and he actually was rushed to the coronary angiography suite, which is where we immediately inject a dye to see where the blockage is so we can open it up and put a stint. And they found the arteries were clean and told him it was probably his gastrointestinal tract because that truly can sometimes mimic a heart attack. And then, the woman just felt real tired and just weak, and she said, "You know what? I am just exhausted and just don't feel right, a little bit dizzy." And everybody says, "Oh, you poor thing, all of the running around, the stress with your husband. It just must be an anxiety spell and we need to have you rest." And she was resting; but fortunately, because her husband was still undergoing tests, someone happened to notice that her blood pressure was a little bit high and maybe the pulse rate was too high for an anxiety. And someone asked for an EKG, and she was in the middle of a heart attack. I put this story up front to suggest to you that it is true that women do have different ways of manifesting heart disease, and I think part of the issues that you heard the previous two speakers really speak to is the fact that we have to recognize what some of the spectrum of these differences are and have a way to help women to be empowered because as they come across healthcare providers, not all of them will be appropriately educated, as you'll see, in terms of making the true diagnosis.

So women have to be their own advocate. So I start out with the issue of the Gold Red, which is a campaign that has been carried out across the country. And I'm very pleased that just about everybody is in red, even the gentlemen who are supporting us here. I appreciate that. But again, I think that this is the American Heart Association logo, but the National Heart, Lung, and Blood Institute; the American College of Cardiology; all the groups that are involved with heart disease have been just as involved in this whole issue of making women more aware. So it is a pertinent question that was asked, what is the number one killer of women, by this American Heart Association national study. I am going to go quickly through this because I know by the second day, you've heard snippets of this survey. The population that was surveyed had 12 percent Blacks. It was a household survey. And I believe you saw some of this data from Dr. Novella, I assume, but I just want to remind you that as you look at heart disease in the left-hand column, in terms of 2003 versus 2000, the American Heart Association has done this survey now over the last three or four years.

There has been some improvement in general, so 2003 is in red, the red bar, and 2000 the green bar. So clearly, there's better awareness, 46 percent overall that heart disease is the leading cause of death for all women, compared to 34 percent just three years ago. So we ought to congratulate the societies and people like Dee Baldwin for the work that's going on in that regard. If you break this down and look at what's happening across the different race and ethnic groups, so you see the Whites in green, the navy blue there is the Black women, and the Hispanics in red. And what you notice is the awareness is greatest for White women, 55 percent; and as Dr. Wenger mentioned, only about 30 percent and 26 percent for Blacks and Hispanics respectively. And that goes along with something that we just can't seem to shake; that is the fact the higher rate of perceived greatest health problem among women for cancer, especially breast cancer. You notice there 46 percent of the Black women perceived breast cancer as their greatest health problem. And again, while that is important, we have to have the proportionality and help women recognize the importance of heart disease. You heard about the fact that women get most of their information from magazines, 45 percent.

I just want go point out that when I spend a lot of my time speaking to healthcare providers, primary and specialty care physicians, and I point to the fact that only one in four women—and much lower numbers for minority women—feel that they can get valuable information or feel that they can ask questions of their physicians. And again, I think that's a challenge for the providers. But again, that's another opportunity for us in speaking to women to say, "You have got to ask the questions." I'm going to just mention this. I was in a dermatologist's office with my daughter, and the dermatologist walks in and says, "Just three problems today. Prioritize." That was a shock today, because my patients always just tell me everything that they've come to the table with. So your doctor may tell you just three problems, but think about that ahead of time if you have that sense so you can communicate. Clearly, you'd heard about the fact that heart disease is the leading cause, and I'm not going to dwell on that. But about 500,000 women die of cardiovascular disease. And for African-American women in the state of Georgia—which is where I can take the reference from and can tell you it's about the same across the Southeast—one in four of these deaths will be premature compared to one in 10 for White women. It is in deed true that hundreds of thousands more women will develop heart disease, and millions more clearly are at risk, as you've heard. But here's a sobering statistic. Two-thirds of women who die suddenly did not have prior symptoms or diagnosis of a heart problem. And again, you heard a little bit about that from Dr. Barbara Yawn.

So the issue, of course, that all of us will speak to is prevention, prevention, prevention. Now, just to point out again, to bring this home, and this is what's really startling to me. Although African-Americans make up 29 percent of the population of Georgia, they account for two-thirds, or 68 percent, of the premature death before the age of 65. And again, someone thought it was interesting because they said, "Well, I don't have to pay into social security." And I said, "Well, no. You're depriving yourself of something you have earned, so you better be there." When we look at African-Americans compared to Whites, we do recognize a higher prevalence, earlier onset, and more severe complications of high blood pressure. You saw the prevalence rates from Dr. Wenger: one and a half times at greater risk of heart disease death; 1.8 times at greater risk of fatal stroke; and most devastating, over 4.2 times at greater risk of M-stage kidney disease and dialysis. So you may have seen this slide over the last day or so.

Just recognize that when it comes to cardiovascular mortality trends overall, you notice there that the women now exceed the men in the yellow bar over time, and that sort of excess happened in the mid '80s. That was driven primarily by a dramatic reduction, as you see with the red line, for men. So that's where some of our efforts have to be, as you've heard, is we've got to reduce the rates in women. You heard some of these facts, and I'm going to go quickly through them, because again, clearly, this is the issue. What are some of the strategies to manage these risk factors? You heard some of that earlier. I want to emphasize that patient factors are key here, because patients clearly must understand and recognize how their symptoms may differ. I believe it's important to share with people what we know about disease processes and how the athroscorotic process is initiated and leads to heart attack. Obviously, there's the issue of having a supportive network; but recognize that sometimes families can actually be a hindrance in terms of what a women will do if she thinks she's having a heart attack. Statistic has shown that women who talk to friends and families about their symptoms tend not to report early enough for treatment. But if a woman shares that symptom with a stranger, she's likely to go into the hospital. I don't know what it is. Maybe we have a way of convincing people that what it is we're feeling, especially if they are family members, is just not that bad. When we think about providers, you heard about the issue of cultural competence, and time will not allow me to dwell into that.

But there are clearly issues with access to care and the level of care that's received, and I think that's why I'm always very interested when we have a group of individuals that are around the table that can speak to the issue of policy. And again, all of us can recognize that there are things we must do to make healthcare accessible, to make drug coverage accessible, and some of that is going to be very important from a policy standpoint. This is what happens when people come to me with a heart attack. They have ruptured a plaque. Unfortunately, it is too late in terms of some of the prevention strategies that we need to do. But the good thing about heart disease is at every stage that there's recognition, there's an opportunity to minimize damage. And of course, you heard about some of the risk factors, so I will not dwell on that. But I want to point out as you look at the lower column on this slide, all of the manifestations of cardiovascular disease—whether you're looking at angina, heart attack, stroke, vascular disease—have the same risk factors. The blood vessels are impacted similarly. So if you have someone who has a family history of stroke or—she's showing me the slide. Yes, Dee, thank you. The athroscorotic process, I want to point out, starts over time; and we know that in people as early as in their 20s and 30s who have had autopsies because of either accidental death that they already have the beginning stages of athroscorosis. But why is this important? It's important because we have an opportunity to prevent this, and even more important, if you begin the management at any stage, you can reverse the impact of this disease on the blood vessels. I want to point to the metabolic syndrome here because I think that you heard about the fact, the problem with obesity.

The metabolic syndrome is this constellation of risk factors that contribute to athroscorosis, what I showed you in the two earlier slides. So high blood pressure, abdominal obesity measured by your waist circumference, fasting, glucose, triglycerides, and HDL cholesterol. Any three of those, the numbers that are shown on the right. Blood pressure does not have to be very high. Over 130 qualifies. For women, a waist circumference of over 30 inches and triglycerides as well as the lipid factors number, glucose numbers that are shown there, again, these are all things that would accelerate the risk of a woman developing heart disease. So this is a publication in the "New England Journal of Medicine," and what you see here is the culmination of what racial and sex and gender bias in medicine means. All of these people you see in front of you are actors and actresses, and they were just programmed at a major medical meeting attended by physicians to describe symptoms so we can see how the physicians would react. The symptoms were described the same way—crushing chest pain, not any of the hard to describe symptoms that I shared with you earlier. They all had good insurance. They all had good jobs. The only difference was the ones on the left were women and the upper column were Blacks. And guess what? The decisions were very different based on these three categories. The women and the Blacks were less likely to be referred for heart catharization than the men. The bottom line from this study was there was a sense among the physicians that the men are more likely to make demands if they didn't get the care; and that the women, particularly Black women, were more likely to be accepting of the diagnosis.

So again, I think that is very subtle, but that is clear that we've got to know so we can ask the questions. So as you look at the issue with the Gold Red campaign in terms of empowering women, the one thing we want to—we want women to remember the number is half a million, and that's the number of women that will die. And of course, what all women can do about this is talk to each other and talk to their family members. And there are issues with risk factors that you already heard, but in the interest of time, I am going to go—this is one about telling someone—to the ABC seven steps to good health, and this is kind of funny. I want you to know that I put this together myself, so if you don't laugh, I'll be hurt. But anyway, the Association of Black Cardiologists has a promotion about what women and men must do to promote good health. At the base of that pyramid is to be spiritually active; then take control of your blood pressure; recognize that for cholesterol, we know that even getting lower and lower is better; eat healthy and exercise, and I was grateful to see that we're going to have some of that today; smoke out; and then finally, health care are us. This is the blood pressure part is to say you've got to know your numbers, and if you're hypertensive, you have to have a way to monitor it at home because clearly, this is the issue of a silent killer.

One of the things that I want to mention on this slide is that we know from the major study that was done that there is something called the Dash Eating Plan where fruits and vegetables contribute significantly to helping control high blood pressure. For cholesterol, the issue is the good, the bad, and the very ugly. And here again, we see that the numbers are pretty clear. What you have to do, where you need to be is on the left. Even the goals are more moderate to the right, your total should not be more than 160. And of course, the good cholesterol needs to be over 60. Abdominal fat is the problem. The good news about all of this is we are learning—and I shared some of this at the end of my opening plan recession—that we have ways now of understanding why women over time, once they accumulate weight around the middle with abdominal obesity, have difficulty losing that weight. It has to do with the central system called the endocabenoid system. We're understanding that system better, and we're recognizing ways that we can modulate that system. Some of it is with exercise, some of it with new medicines that will be tested.

And so, you know, there's health around the way; but in the meantime, choose your diet. South Beach, Atkins, I don't care what you like. Clearly, we need to modulate carbohydrates because energy in equals energy out. Calories in and no energy out equals more weight. I hope you guys are liking that. So finally, relaxation. Take five. I like this especially because I said you've got to breathe. You've got to imagine the beautiful things in life that make you happy. You have to rest in pieces, remember now, in pieces because, you know, you've got to just let it go. And I like the opening that our co-chair brought in that regard. Visualize, and of course, do the right thing. Most importantly, I want everybody to recognize the early warning signs of heart attacks, stroke or brain attack, kidney failure, dialyses, glaucoma, diabetes. Obviously, there's got to be a partnership with your physician; but we have to be motivated to make our physicians do what it is they need to do for us. I'm a believer that in most families, there ought to be someone who knows CPR, because that certainly can be lifesaving.

There are many issues with alternative medicines and supplements. Know what it is you're taking and educate yourself about it. And so in terms of what the doctor ordered, there are many drugs out there. I want to tell you that the long list is not to be intimidating, but you have to be educated if you have any of the heart problems to know what has been tested and what is likely to be effective whether you have high blood pressure or have suffered a heart attack. And finally, reach out and learn. I put for forwomen.gov at the beginning there, and thank you very much, Dee. My time is up.