By Emily Leslie – The Washington Times – Sunday, July 12, 2015

Barbra Streisand continues to fight the No. 1 killer of women in the United States: heart disease. As co-founder of the Women’s Heart Alliance, the entertainer is addressing gender disparity in medical research and calling for action on women’s heart health.

“Women are the center of the family, and every woman lost is someone’s mother, wife, daughter, sister, aunt or friend,” she said at The New York Times’ Women in the World Summit in May. “But too few women know they need to be fighting back — or how.

Miss Streisand launched her Fight the Ladykiller campaign through the Women’s Heart Alliance to raise awareness of heart disease, which kills more women than all types of cancer combined.

“Heart disease kills one woman every minute,” Miss Streisand said in a statement released to The Washington Times. “Yet as a nation, we’re not talking about this injustice, we’re not raising the alarm bells, and we’re not taking bold steps to prevent and treat heart disease in women.”

“We are just at the beginning of understanding the difference between the sexes when it comes to heart disease,” Dr. C. Noel Bairey Merz said on the Barbra Streisand Women’s Heart Center website, where she serves as director.

Heart disease kills more women than men, yet most medical research on the disease is underfunded and conducted primarily with male participants, Miss Streisand said.

“Women are only 35 percent of participants in all heart-related studies. Even the mice in the labs are male. And the National Institutes of Health, with a budget of $30.2 billion, gives only a tiny fraction of that to women’s heart disease,” she said at the Women’s Heart Alliance Ambassador Tea in May.

“That’s ridiculous. I mean, how can you treat a woman for such a life-threatening ailment based on treatments created for men?”

Learning the symptoms

Women’s heart attacks are often misdiagnosed and untreated because the symptoms are different from the “classic Hollywood heart attack.” Although men have the unmistakable pain in the left arm and chest, nearly half of women instead will experience nausea, fatigue, jaw pain and back pain.

“I find it outrageous that many doctors don’t know the differences between women and men’s hearts or that women can have much different and subtler heart attack symptoms than men. And, therefore, many doctors use diagnostic tools on women that were designed for and tested on men,” Miss Streisand said.

This is referred to as “the Yentl Syndrome,” which Dr. Bernadine Healy coined in 1991 when she was head of the National Institutes of Health. The phrase derives from Miss Streisand’s 1983 film “Yentl,” in which her character pretends to be male in order to receive equal education.

Similarly, if women do not present classic heart attack symptoms, they tend to receive poorer medical care.

“This is partly because zero medical schools in this country have a course on women’s cardiovascular disease,” Miss Streisand said. “Not one med school in the U.S. is focused on educating future doctors about women’s unique signs, symptoms and diagnoses.

“Doctors are misinformed about women’s unique traits, and women are left being treated as second-class citizens. This is unjust and has to change.”

Gender gap

The National Heart, Lung and Blood Institute, a branch of the NIH, is making strides in closing the gender gap in medical research and treatment. Dr. Nakela Cook, chief of staff at the institute, said the division uses mostly women in their studies.

“In fiscal year 2013, 68 percent of participants in NHLBI-funded cardiovascular clinical trials were women and 32 percent were men,” said Dr. Cook. “These statistics include the Women’s Health Initiative, which is dedicated to women’s health research. Excluding the Women’s Health Initiative, 46 percent of participants are women and 54 percent are men in NHLBI-funded clinical trials.”

In a May 2014 Nature commentary, directors Janine Clayton and Francis Collins of NIH revealed new requirements for NIH-funded preclinical researchers to take a “balanced approach” in addressing gender differences in cells and animals to “ensure that both men and women get the full benefit of medical research,” Dr. Cook said.

“Increasing women’s participation in clinical research studies is an important goal, but we also seek to encourage researchers to analyze and report their data to understand potential differences between men and women,” Dr. Cook said.

Although NHLBI has made progress with female inclusion in cardiovascular research, the institute “recognize[s] that more work is needed.”

“We must strive to include women in clinical trials that address these specific disorders in proportion to the number of women affected,” Dr. Cook said.

Too often, doctors approach women’s heart disease in a reactive rather than a proactive manner, Miss Streisand said. Education and awareness about disease risk and prevention, she said, is the best way to tackle this deadly disease head-on.

“We need to do a better job educating women about their risks for cardiovascular disease and empower them to take charge of their health to prevent heart disease,” Miss Streisand said.

“Doctors play a crucial role, too,” she said. “They must talk to their patients about women’s heart health, risk factors and disease prevention. And our elected officials need to invest more research dollars toward finding new treatments for women’s heart disease. We all play a part in improving health outcomes for women.”

Miss Streisand said the medical establishment and society as a whole need to do a better job of educating women about the risks for cardiovascular disease so women can “become empowered advocates for [themselves].”

Raising awareness

Miss Streisand urges women to write their members of Congress to encourage them to provide more funding for research on women’s heart disease.

“Here’s the difference,” she said at the Women in the World Summit. “Breast cancer, that kills one in 31 the NIH gives them $959 million a year in research money. Heart disease that kills one in three gets less than a quarter of that, $246 million. Why is that?

“We need your help in raising awareness like the breast cancer campaign has done,” she said.