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Understanding a Treatment Option for Advanced Kidney Cancer

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(Family Features) When kidney cancer spreads or becomes advanced, it can be challenging to treat. Common signs and symptoms can include blood in urine, lower back pain on one side, a mass on the side or lower back, loss of appetite or unexplained weight loss.

While a diagnosis of advanced kidney cancer can be overwhelming, there are steps patients can take to feel more empowered as they face the disease, starting with learning about the treatments that may be available for them.

Exploring Your Options
When facing advanced kidney cancer, it’s important for patients and caregivers to have open communication with their healthcare team to understand the diagnosis and establish a treatment plan.

Asking questions to understand where the cancer has spread, what the expected prognosis is and the potential benefits of treatment – including the possibility to live longer – can be critical to aligning on a path forward.

Fortunately, there are several types of medicines available for advanced kidney cancer today, depending on the specifics of each patient’s disease. Chemotherapy, targeted therapy or immunotherapy are a few types of treatment that may be considered, sometimes in combination. Immunotherapy works differently than chemotherapy or targeted therapy, as it helps a person’s own immune system to fight cancer and can enable the immune system to find and attack cancer cells. For some patients, dual immunotherapy – or a combination of two immunotherapy treatments – may be recommended.

For example, Opdivo (nivolumab) + Yervoy (ipilimumab) is approved by the U.S. Food and Drug Administration (FDA) as a combination of two immunotherapies for certain newly diagnosed adults whose kidney cancer (also referred to as renal cell carcinoma) has spread. It is not known if Opdivo is safe and effective in children younger than 18 years of age. Opdivo (10 mg/mL) and Yervoy (5 mg/mL) are injections for intravenous use.

This combination of two immunotherapies has the potential to work with the immune system in different but complementary ways to help fight cancer. While Yervoy may stimulate the kind of cells that help fight cancer, Opdivo may help these cells find and fight the cancer cells again.

While doing so, this immunotherapy combination can also affect healthy cells. These problems can sometimes become serious or life threatening and can lead to death. These problems may happen anytime during treatment or even after treatment has ended. You may have more than one of these problems at the same time. Some of these problems may happen more often when Opdivo is used in combination with Yervoy.

Opdivo and Yervoy can cause problems that can sometimes become serious or life-threatening and can lead to death. Serious side effects may include lung problems; intestinal problems; liver problems; hormone gland problems; kidney problems; skin problems; eye problems; problems in other organs and tissues; severe infusion reactions; and complications of stem cell transplant, including graft-versus-host disease (GVHD), that uses donor stem cells (allogeneic). Call or see your healthcare provider right away for any new or worsening signs or symptoms. Please see additional Important Safety Information below.

Understanding Overall Survival
One of the most important considerations for choosing a treatment is the potential for survival, or the chance to live longer. Overall survival is sometimes reported as a survival rate, which is the percentage of people in a clinical trial who are still alive for a certain time period after being diagnosed with or starting treatment for a disease, such as cancer.

“After my cancer diagnosis, my wife and I prayed about our future and pursuing every avenue with that goal in mind,” said Terry Broussard, who has been living with advanced kidney cancer. “I wanted a treatment that may give me a chance to live longer in order to see my youngest child graduate high school.”

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Broussard’s doctor recommended treatment with Opdivo + Yervoy, which has overall survival data at five years. The FDA approval of this dual immunotherapy in advanced renal cell carcinoma (RCC) was based on results from the CheckMate -214 clinical trial, which included 847 previously untreated patients with kidney cancer that had spread and with one or more risk factors.

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In the primary analysis at two years (25.2 months), the length of time patients lived without tumors worsening was 11.6 months for this immunotherapy combination and 8.4 months for sunitinib. There was no meaningful difference between the two treatments.

Researchers also assessed the overall response rate, which is a measure of the percentage of patients whose cancer shrunk (partial response) or disappeared completely (complete response) after treatment.

At the two-year time point, 41.6% of patients treated with Opdivo + Yervoy (95% CI:36.9-46.5) responded to treatment (n=177/425) versus 26.5% (n=112/422) of those treated with sunitinib (95% CI:22.4-31.0). Partial tumor shrinkage occurred in 32.2% of the patients treated with this immunotherapy combination compared to 25.4% of those treated with sunitinib. Tumors disappeared completely in 9.4% of patients treated with this immunotherapy combination versus in 1.2% of patients treated with sunitinib. The disappearance of any measurable tumors in response to treatment does not necessarily mean the cancer has been cured. Opdivo + Yervoy will not work for everyone. Individual results may vary.

“Advanced kidney cancer is a complex disease with many treatment options, which can feel overwhelming for people facing a devastating cancer diagnosis,” said Ulka Vaishampayan, M.D., professor, Internal Medicine, Division of Hematology/Oncology, University of Michigan. “The goal of treatment is to help patients live longer, and research like these five-year data gives us insight into what treatment with Opdivo + Yervoy may look like for patients from the trial over time.”

The most common side effects of Opdivo, when used in combination with Yervoy, include: feeling tired; diarrhea; rash; itching; nausea; pain in muscles, bones, and joints; fever; cough; decreased appetite; vomiting; stomach-area (abdominal) pain; shortness of breath; upper respiratory tract infection; headache; low thyroid hormone levels (hypothyroidism); constipation; decreased weight; and dizziness.

Establishing and Leaning on a Support System
From diagnosis to treatment and beyond, many patients find the support from family, friends and loved ones invaluable. Identifying a friend, spouse or caregiver who can join doctor appointments, ask questions and take notes can be a helpful way to track all the details that can often be overwhelming when facing cancer. “I’ve been incredibly lucky to have the support of my wife, children, nurses and doctors every step of the way,” said Broussard. “Even in the most challenging moments, knowing they were by my side gave me the hope and inspiration I needed to continue moving forward.”

To learn more, visit Opdivo.com.

Source: Bristol Myers Squibb

Photo caption: Terry Broussard and his wife, Tracy. Broussard is an actual patient who has been compensated by Bristol Myers Squibb for his time.

INDICATION AND IMPORTANT SAFETY INFORMATION
OPDIVO® (nivolumab) is a prescription medicine used in combination with YERVOY® (ipilimumab) to treat adults with kidney cancer in certain people when your cancer has spread (advanced renal cell carcinoma) and you have not already had treatment for your advanced RCC.

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It is not known if OPDIVO is safe and effective in children younger than 18 years of age.

Information provided in this article is not a substitute for talking with your healthcare professional. Your healthcare professional is the best source of information about your disease.

Important Safety Information for OPDIVO® (nivolumab) + YERVOY® (ipilimumab)
What is the most important information I should know about OPDIVO + YERVOY?
OPDIVO and YERVOY are medicines that may treat certain cancers by working with your immune system. OPDIVO and YERVOY can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. These problems may happen anytime during treatment or even after your treatment has ended. You may have more than one of these problems at the same time. Some of these problems may happen more often when OPDIVO is used in combination with another therapy.

What are the serious side effects of OPDIVO + YERVOY?
Call or see your healthcare provider right away if you develop any new or worse signs or symptoms, including:

  • Lung problems: new or worsening cough; shortness of breath; chest pain
  • Intestinal problems: diarrhea (loose stools) or more frequent bowel movements than usual; stools that are black, tarry, sticky, or have blood or mucus; severe stomach-area (abdominal) pain or tenderness
  • Liver problems: yellowing of your skin or the whites of your eyes; severe nausea or vomiting; pain on the right side of your stomach area (abdomen); dark urine (tea colored); bleeding or bruising more easily than normal
  • Hormone gland problems: headaches that will not go away or unusual headaches; eye sensitivity to light; eye problems; rapid heart beat; increased sweating; extreme tiredness; weight gain or weight loss; feeling more hungry or thirsty than usual; urinating more often than usual; hair loss; feeling cold; constipation; your voice gets deeper; dizziness or fainting; changes in mood or behavior, such as decreased sex drive, irritability, or forgetfulness
  • Kidney problems: decrease in your amount of urine; blood in your urine; swelling in your ankles; loss of appetite
  • Skin problems: rash; itching; skin blistering or peeling; painful sores or ulcers in the mouth or nose, throat, or genital area
  • Eye problems: blurry vision, double vision, or other vision problems; eye pain or redness.

Problems can also happen in other organs and tissues. These are not all of the signs and symptoms of immune system problems that can happen with OPDIVO and YERVOY. Call or see your healthcare provider right away for any new or worsening signs or symptoms, which may include:

  • Chest pain; irregular heart beat; shortness of breath; swelling of ankles
  • Confusion; sleepiness; memory problems; changes in mood or behavior; stiff neck; balance problems; tingling or numbness of the arms or legs
  • Double vision; blurry vision; sensitivity to light; eye pain; changes in eye sight
  • Persistent or severe muscle pain or weakness; muscle cramps
  • Low red blood cells; bruising

Getting medical help right away may help keep these problems from becoming more serious. Your healthcare team will check you for these problems during treatment and may treat you with corticosteroid or hormone replacement medicines. Your healthcare team may also need to delay or completely stop your treatment if you have severe side effects.

Possible side effects of OPDIVO + YERVOY
OPDIVO and OPDIVO + YERVOY can cause serious side effects, including:

  • See “What is the most important information I should know about OPDIVO + YERVOY?”
  • Severe infusion reactions. Tell your healthcare team right away if you get these symptoms during an infusion of OPDIVO or YERVOY: chills or shaking; itching or rash; flushing; shortness of breath or wheezing; dizziness; feel like passing out; fever; back or neck pain
  • Complications, including graft-versus-host disease (GVHD), of bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). These complications can be severe and can lead to death. These complications may happen if you underwent transplantation either before or after being treated with OPDIVO or YERVOY. Your healthcare provider will monitor you for these complications.

The most common side effects of OPDIVO, when used in combination with YERVOY, include: feeling tired; diarrhea; rash; itching; nausea; pain in muscles, bones, and joints; fever; cough; decreased appetite; vomiting; stomach-area (abdominal) pain; shortness of breath; upper respiratory tract infection; headache; low thyroid hormone levels (hypothyroidism); constipation; decreased weight; and dizziness.

These are not all the possible side effects. For more information, ask your healthcare provider or pharmacist. You are encouraged to report side effects of prescription drugs to the FDA. Call 1-800-FDA- 1088.

Before receiving OPDIVO or YERVOY, tell your healthcare provider about all of your medical conditions, including if you:

  • have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus
  • have received an organ transplant
  • have received or plan to receive a stem cell transplant that uses donor stem cells (allogeneic)
  • have received radiation treatment to your chest area in the past and have received other medicines that are like OPDIVO
  • have a condition that affects your nervous system, such as myasthenia gravis or Guillain-Barré syndrome
  • are pregnant or plan to become pregnant. OPDIVO and YERVOY can harm your unborn baby
  • are breastfeeding or plan to breastfeed. It is not known if OPDIVO or YERVOY passes into your breast milk. Do not breastfeed during treatment with OPDIVO or YERVOY and for 5 months after the last dose of OPDIVO or YERVOY.

Females who are able to become pregnant:
Your healthcare provider should do a pregnancy test before you start receiving OPDIVO or YERVOY.

  • You should use an effective method of birth control during your treatment and for at least 5 months after the last dose of OPDIVO or YERVOY. Talk to your healthcare provider about birth control methods that you can use during this time.
  • Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with OPDIVO or YERVOY. You or your healthcare provider should contact Bristol-Myers Squibb at 1-844-593-7869 as soon as you become aware of a pregnancy.

Tell your healthcare provider about all the medicines you take, including prescription and over-the- counter medicines, vitamins, and herbal supplements.

Please see U.S. Full Prescribing Information and Medication Guide for OPDIVO and YERVOY.

© 2023 Bristol-Myers Squibb Company. All Rights Reserved.

OPDIVO® and YERVOY® are registered trademarks of Bristol-Myers Squibb Company.

7356-US-2200719 2/23

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Bristol Myers Squibb

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    Josh is a native Phoenician, lives in the west Valley with his wife, daughter and two sons. He has a BA in Management and 24 years of experience in Information Technology. Joshua also has multiple publications for IT education, which are used in universities around the world.

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Josh is a native Phoenician, lives in the west Valley with his wife, daughter and two sons. He has a BA in Management and 24 years of experience in Information Technology. Joshua also has multiple publications for IT education, which are used in universities around the world.

Lifestyle

8 Ways to Help Protect Your Vision Right Now

As you get older, your risk for some eye diseases may increase. However, there are steps you can take to keep your eyes healthy – and it starts with taking care of your overall health. Set yourself up for a lifetime of seeing your best with these eight tips in honor of Healthy Vision Month. Protect Your Vision!

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Protect Your Vision

8 Ways to Help Protect Your Vision Right Now

(Feature Impact) As you get older, your risk for some eye diseases may increase. However, there are steps you can take to keep your eyes healthy – and it starts with taking care of your overall health.

Set yourself up for a lifetime of seeing your best with these eight tips from the experts at the National Eye Institute in honor of Healthy Vision Month:

1. Find an eye doctor you trust.
Many eye diseases don’t have any early symptoms, so you could have a problem and not know it. An eye doctor can help you stay on top of your eye health. Find an eye doctor you trust by asking friends and family if they like their doctors. You can also check with your health insurance plan to find eye doctors near you.

2. Ask how often you need a dilated eye exam.
Getting a dilated eye exam is the single best thing you can do for your eye health. It’s the only way to find eye diseases early, when they’re easier to treat – and before they cause vision loss. Your eye doctor will decide how often you need an exam based on your risk for eye diseases.

3. Add more movement to your day.
Physical activity can lower your risk for health conditions that can affect your vision, like diabetes and high blood pressure. If you have trouble finding time for physical activity, try building it into other activities. Walk around while you’re on the phone, do push-ups or stretch while you watch TV or dance while you’re doing chores. Anything that gets your heart pumping counts.

4. Get your family talking about eye health history.
Some eye diseases – like glaucoma and age-related macular degeneration – can run in families. While it may not be the most exciting topic of conversation, talking about your family health history can help everyone stay healthy. The next time you’re chatting with relatives, ask if anyone knows about eye problems in your family. Be sure to share what you learn with your eye doctor to see if you need to take steps to lower your risk.

5. Step up your healthy eating game.
Eating healthy foods helps prevent health conditions – like diabetes or high blood pressure – that can put you at risk for eye problems. Eat right for your sight by adding more eye-healthy foods to your plate, such as dark, leafy greens like spinach, kale and collard greens, and fish high in omega-3 fatty acids like halibut, salmon or tuna.

6. Make a habit of wearing your sunglasses – even on cloudy days.
The sun’s UV rays can not only harm your skin, but the same goes for your eyes. However, wearing sunglasses that block 99-100% of both UVA and UVB radiation can protect your eyes and lower your risk for cataracts.

7. Stay on top of long-term health conditions like diabetes and high blood pressure.
Diabetes and high blood pressure can increase your risk for some eye diseases, like glaucoma. If you have diabetes or high blood pressure, ask your doctor about steps you can take to manage your condition and lower your risk of vision loss.

8. If you smoke, make a plan to quit.
Quitting smoking is good for your entire body, including your eyes. Kicking the habit can help lower your risk for eye diseases like macular degeneration and cataracts. Quitting smoking is hard, but it’s possible – and a plan can help.

Test your eye health knowledge with a quick quiz and find more vision resources at nei.nih.gov/hvm.

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Photo courtesy of Shutterstock

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National Eye Institute

Our Lifestyle section on STM Daily News is a hub of inspiration and practical information, offering a range of articles that touch on various aspects of daily life. From tips on family finances to guides for maintaining health and wellness, we strive to empower our readers with knowledge and resources to enhance their lifestyles. Whether you’re seeking outdoor activity ideas, fashion trends, or travel recommendations, our lifestyle section has got you covered. Visit us today at https://stmdailynews.com/category/lifestyle/ and embark on a journey of discovery and self-improvement.

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Lifestyle

Tobacco is still one of the world’s top killers – here are the key obstacles to enacting generational smoking bans

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Smoking is really bad for you. Most people know that. Even smokers think smoking is bad for one’s health. But most people don’t know just how bad it is.
Cigarette display at a 7-Eleven convenience store in Miami, Fla., in July 2025. Jeffrey Greenberg/Universal Images Group via Getty Images

Marie Helweg-Larsen, Dickinson College

Smoking is really bad for you. Most people know that. Even smokers think smoking is bad for one’s health. But most people don’t know just how bad it is.

More people in the United States die every year from smoking than from alcohol, illegal drug use, car accidents, suicides and murders combined. Cigarette smoking costs an estimated US$240 billion annually in health care costs, which harm not only smokers but also nonsmokers, communities and the economy. Smoking is the top preventable cause of death and disease in the U.S. and worldwide.

The number of smokers in the U.S. has declined from 41% in 1944 to 11% in 2024. However, over 25 million Americans still smoke.

This drop is partly the result of many smoking laws enacted in the past 50 years. They include national bans on cigarette advertising on television and radio (1971), smoking on commercial flights (2000), sale of fruit- or candy-flavored cigarettes (2009), and sale of cigarettes to people ages 18 to 20 (2019). New policies might seem as strange or unfamiliar as these measures did at the time.

One potentially transformative idea – creating a tobacco-free generation – would build on these past laws. It would phase out smoking by banning it permanently for anyone born after a specific date. For example, a law could make it illegal for anyone under 21 to ever buy cigarettes, whereas people age 21 or older at the time would not be affected. The focus would be on tobacco sales, which already require age verification in the U.S., not on criminalizing tobacco use.

As a psychological scientist, I have studied for decades how people think about smoking. In my view, the key obstacle to creating future generations of nonsmokers is that people do not fully understand how dangerous smoking is and do not realize the formidable influence of the tobacco industry.

Creating a tobacco-free generation

The idea of creating a tobacco-free generation was first proposed by health researchers in 2010. In 2021 the town of Brookline, Massachusetts, became the first U.S. community to adopt it. Brookline’s ordinance prohibits tobacco and vape sales to anyone born on or after Jan. 1, 2000. It has survived a legal challenge and has been emulated in 22 more Massachusetts towns.

As of early 2026, Hawaii and Massachusetts are considering statewide tobacco-free generation bills. Abroad, the Maldives enacted the first countrywide ban in 2025.

Similar proposals have faced pushback elsewhere. In New Zealand, a ban was adopted in 2022 but repealed in 2024. The United Kingdom is considering a similar bill after an earlier version was scrapped due to a snap election.

Why people underestimate harm from cigarettes

It is hard to visualize what exactly it means that 480,000 people in the U.S. die from smoking every year or that each cigarette that you smoke shortens your life by 20 minutes. It is also easy to feel optimistically biased about one’s personal risk as a smoker and believe that others are more likely to become addicted or die prematurely.

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Studies show that nonsmokers, former smokers and current smokers underestimate smoking risks. One likely reason is messaging by the tobacco industry, which claimed for decades that cigarettes were safe, even though tobacco industry scientists knew as early as 1953 that smoking caused lung cancer.

Another factor is glamorization of cigarettes in movies. Fully half of the top films released in 2024 showed tobacco imagery, typically of cigarettes. Research shows that adolescents and young adults who watch smoking in movies are more interested in taking up smoking.

Finally, smoking deaths may seem to be unremarkable because some of the illnesses that cigarette smoking causes, such as heart disease or cancer, are commonplace. And unlike deaths from drug overdoses, we do not always see the consequences of a lifetime of smoking. https://www.youtube.com/embed/2mKyosQbFNY?wmode=transparent&start=0 Smoking imagery is widespread in popular culture and may be one driver of tobacco use, especially among young Americans.

What about freedom of choice?

A common argument against laws that regulate personal choices, such as whether to smoke or wear seat belts, is that people prize their autonomy and don’t like governments telling them how to live. This isn’t a new challenge for public health policies, which often restrict private citizens’ freedom to do as they wish.

People can be persuaded that community action should trump individual choice if a behavior, such as smoking cigarettes or driving while drunk, harms others who don’t engage in it. Many public health laws are designed to protect people who are innocent or vulnerable. For example, current smoking laws have been enacted in part to protect nonsmokers who are exposed to secondhand smoke, especially children. And smoking increases health care costs for everyone, not just smokers.

By preventing people in the U.S. who cannot legally buy cigarettes now from ever doing so, generational smoking bans balance the rights of current adult smokers against the major public health benefits of a phased smoking ban that will eventually end the smoking epidemic.

Arguments against generational smoking laws

The tobacco industry’s attempts to undermine tobacco health policies are well documented and follow a predictable pattern. For example, when the U.K. government considered a generational smoking policy in 2023, tobacco companies and their supporters argued that smoking was a minor problem, that individuals should be responsible for their own choices, and that a nationwide ban would lead to illegal behavior or hurt business profits.

In a 2025 study assessing how Belgian politicians viewed generational smoking bans, researchers heard similar arguments. Respondents across the political spectrum valued personal freedom and informed individual choice more highly than protecting children. The politicians also believed that young people could understand how smoking affected their health, and that raising awareness was more important than bans. These arguments aligned with tobacco industry positions.

However, research shows that young people hold many optimistic beliefs about smoking, especially with respect to the addictiveness of nicotine and the likelihood that they will avoid becoming lifelong smokers. Studies have also found that adolescents don’t know enough to make an informed choice to smoke. These findings matter because the tobacco industry routinely targets young people in an effort to create lifelong smokers.

The tobacco industry’s harm reduction approach frames e-cigarettes, also known as vapes, as a way to create a smoke-free future by transitioning smokers to other nicotine products. But research shows that the tobacco industry actively markets nicotine products such as vapes to young people to create a new generation of nicotine users.

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Not a silver bullet

Curbing the use of an addictive product is challenging, and there are ways for young people to obtain cigarettes illegally, as they do now in places where cigarette buyers must be at least 21. Tactics include shopping at stores that don’t check IDs, having older friends buy cigarettes and purchasing cigarettes illegally online.

Tobacco-free generation policies aren’t a silver bullet. They work most effectively in conjunction with other measures, such as plain packaging; high prices; bans on displays, advertising and flavored products; smoking cessation support; and public health messages making clear that cigarettes are unsafe at any age.

Still, health experts and groups including the American Heart Association and the American College of Cardiology argue that creating a tobacco-free generation could dramatically reduce preventable deaths and secure a healthier future for today’s children and future generations. In my view, understanding the obstacles to change is a critical step toward achieving this goal.

Marie Helweg-Larsen, Professor of Psychology, Dickinson College

This article is republished from The Conversation under a Creative Commons license. Read the original article.

STM Daily News is a vibrant news blog dedicated to sharing the brighter side of human experiences. Emphasizing positive, uplifting stories, the site focuses on delivering inspiring, informative, and well-researched content. With a commitment to accurate, fair, and responsible journalism, STM Daily News aims to foster a community of readers passionate about positive change and engaged in meaningful conversations. Join the movement and explore stories that celebrate the positive impacts shaping our world. 

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Lifestyle

Women are at a higher risk of dying from heart disease − in part because doctors don’t take major sex and gender differences into account

Heart disease impacts women differently than men due to genetic and gender biases in healthcare. Awareness and improved treatment approaches are essential for better outcomes.

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Last Updated on April 20, 2026 by Daily News Staff

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Amy Huebschmann, University of Colorado Anschutz Medical Campus and Judith Regensteiner, University of Colorado Anschutz Medical Campus

A simple difference in the genetic code – two X chromosomes versus one X chromosome and one Y chromosome – can lead to major differences in heart disease. It turns out that these genetic differences influence more than just sex organs and sex assigned at birth – they fundamentally alter the way cardiovascular disease develops and presents.

While sex influences the mechanisms behind how cardiovascular disease develops, gender plays a role in how healthcare providers recognize and manage it. Sex refers to biological characteristics such as genetics, hormones, anatomy and physiology, while gender refers to social, psychological, and cultural constructs. Women are more likely to die after a first heart attack or stroke than men. Women are also more likely to have additional or different heart attack symptoms that go beyond chest pain, such as nausea, jaw pain, dizziness and fatigue. It is often difficult to fully disentangle the influences of sex on cardiovascular disease outcomes versus the influences of gender.

While women who haven’t entered menopause have a lower risk of cardiovascular disease than men, their cardiovascular risk accelerates dramatically after menopause. In addition, if a woman has Type 2 diabetes, her risk of heart attack accelerates to be equivalent to that of men, even if the woman with diabetes has not yet gone through menopause. Further data is needed to better understand differences in cardiovascular disease risk among nonbinary and transgender patients.

Despite these differences, one key thing is the same: Heart attack, stroke and other forms of cardiovascular disease are the leading cause of death for all people, regardless of sex or gender.

We are researchers who study women’s health and the way cardiovascular disease develops and presents differently in women and men. Our work has identified a crucial need to update medical guidelines with more sex-specific approaches to diagnosis and treatment in order to improve health outcomes for all.

Gender differences in heart disease

The reasons behind sex and gender differences in cardiovascular disease are not completely known. Nor are the distinct biological effects of sex, such as hormonal and genetic factors, versus gender, such as social, cultural and psychological factors, clearly differentiated.

What researchers do know is that the accumulated evidence of what good heart care should look like for women compared with men has as many holes in it as Swiss cheese. Medical evidence for treating cardiovascular disease often comes from trials that excluded women, since women for the most part weren’t included in scientific research until the NIH Revitalization Act of 1993. For example, current guidelines to treat cardiovascular risk factors such as high blood pressure are based primarily on data from men. This is despite evidence that differences in the way that cardiovascular disease develops leads women to experience cardiovascular disease differently.

a man checking the elderly woman s blood pressure using sphygmomanometer
Photo by Gustavo Fring on Pexels.com

In addition to sex differences, implicit gender biases among providers and gendered social norms among patients lead clinicians to underestimate the risk of cardiac events in women compared with men. These biases play a role in why women are more likely than men to die from cardiac events. For example, for patients with symptoms that are borderline for cardiovascular disease, clinicians tend to be more aggressive in ordering artery imaging for men than for women. One study linked this tendency to order less aggressive tests for women partly to a gender bias that men are more open than women to taking risks.

In a study of about 3,000 patients with a recent heart attack, women were less likely than men to think that their heart attack symptoms were due to a heart condition. Additionally, most women do not know that cardiovascular disease is the No. 1 cause of death among women. Overall, women’s misperceptions of their own risk may hold them back from getting a doctor to check out possible symptoms of a heart attack or stroke.

These issues are further exacerbated for women of color. Lack of access to health care and additional challenges drive health disparities among underrepresented racial and ethnic minority populations.

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Sex difference in heart disease

Cardiovascular disease physically looks different for women and men, specifically in the plaque buildup on artery walls that contributes to illness.

Women have fewer cholesterol crystals and fewer calcium deposits in their artery plaque than men do. Physiological differences in the smallest blood vessels feeding the heart also play a role in cardiovascular outcomes.

Women are more likely than men to have cardiovascular disease that presents as multiple narrowed arteries that are not fully “clogged,” resulting in chest pain because blood flow can’t ratchet up enough to meet higher oxygen demands with exercise, much like a low-flow showerhead. When chest pain presents in this way, doctors call this condition ischemia and no obstructive coronary arteries. In comparison, men are more likely to have a “clogged” artery in a concentrated area that can be opened up with a stent or with cardiac bypass surgery. Options for multiple narrowed arteries have lagged behind treatment options for typical “clogged” arteries, which puts women at a disadvantage.

In addition, in the early stages of a heart attack, the levels of blood markers that indicate damage to the heart are lower in women than in men. This can lead to more missed diagnoses of coronary artery disease in women compared with men.

The reasons for these differences are not fully clear. Some potential factors include differences in artery plaque composition that make men’s plaque more likely to rupture or burst and women’s plaque more likely to erode. Women also have lower heart mass and smaller arteries than men even after taking body size into consideration.

Reducing sex disparities

Too often, women with symptoms of cardiovascular disease are sent away from doctor’s offices because of gender biases that “women don’t get heart disease.”

Considering how symptoms of cardiovascular disease vary by sex and gender could help doctors better care for all patients.

One way that the rubber is meeting the road is with regard to better approaches to diagnosing heart attacks for women and men. Specifically, when diagnosing heart attacks, using sex-specific cutoffs for blood tests that measure heart damage – called high-sensitivity troponin tests – can improve their accuracy, decreasing missed diagnoses, or false negatives, in women while also decreasing overdiagnoses, or false positives, in men.

Our research laboratory’s leaders, collaborators and other internationally recognized research colleagues – some of whom partner with our Ludeman Family Center for Women’s Health Research on the University of Colorado Anschutz Medical Campus – will continue this important work to close this gap between the sexes in health care. Research in this field is critical to shine a light on ways clinicians can better address sex-specific symptoms and to bring forward more tailored treatments.

The Biden administration’s recent executive order to advance women’s health research is paving the way for research to go beyond just understanding what causes sex differences in cardiovascular disease. Developing and testing right-sized approaches to care for each patient can help achieve better health for all.

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Amy Huebschmann, Professor of Medicine, University of Colorado Anschutz Medical Campus and Judith Regensteiner, Professor of Medicine, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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