Health & Wellness |Ask your healthcare provider if a CT calcium screen is right for you

by Tim Ditman
OSF Healthcare

Ash Al-Dadah, MD

URBANA - Here’s something new to bring up the next time you visit your health care provider: Should I undergo a CT calcium score screen to take stock of my heart health? It’s not for everybody, but it could mean the difference between a long, healthy life and finding yourself on an operating table.

“The number one killer in the United States is heart disease,” says Ash Al-Dadah, MD, an interventional cardiologist at OSF HealthCare. “We have to do a better job.

“This calcium scoring is a screening where we may say ‘Hey, you need to exercise more’ or ‘Hey, we just found out you have high blood pressure. Let’s control that.’ or ‘Hey, you’re a smoker. Maybe you need to quit that,’” he adds. “We go after the risk factors that precipitate and lead to heart disease. It’s a wake-up call. Getting ahead of things so you’re not coming in with a heart attack and damage to the heart muscle. At that point, it’s too late.”

The screening

Dr. Al-Dadah says the 15-minute or so, non-invasive procedure is similar to other CT [computed tomography] scans. “A fancy X-ray,” he calls it. You lie down, and a doughnut-looking device surrounds you and takes pictures of your heart.

“The arteries in our heart are supposed to be flesh and appear gray [on the imaging]. As we roll the body through the scan, we want to see all gray,” Dr. Al-Dadah explains. “But if there’s hardening and plaque formation in the arteries, it will light up as white. That’s because plaque as it ages forms calcification. There are calcium deposits.”

You could be told you’re at low, medium or high risk. Or, providers may look at the results based on your age compared to the typical amount of plaque found in a person of that age.

Put simply: “It’s one way to measure risk for heart disease,” Dr. Al-Dadah says. “The most common heart disease is blocked arteries, leading to a risk for heart attacks and other issues.”Cardiologists and radiologists have a scoring system based on how much plaque is found.

Next steps

Dr. Al-Dadah says if your screen comes back with red flags, you’ll want to see a cardiologist to discuss next steps. That could mean more tests, especially if you have daily symptoms like chest pain or shortness of breath:

• A stress test, where you walk and run on a treadmill while providers see how your heart functions.
• A coronary angiogram, which provides more comprehensive images of your arteries.
• Or, a provider could recommend you get another CT calcium screen in a few years.

Plaque in heart

Other treatment options for milder cases: “Even if your cholesterol level is normal, I could still put you on a medication class called statins. Statins reduce plaque thickness. They stabilize the plaque and reduce the risk for heart attack,” Dr. Al-Dadah outlines.

“I could put you on aspirin. Aspirin will dramatically reduce the risk for a heart attack if you have significant plaque,” he adds.

One other outcome of note: Though rare, Dr. Al-Dadah says your CT calcium screen could come back OK, but you could still have a heart issue soon after. No screening is a silver bullet to keep you 100% healthy, in other words. That’s why it’s important to follow your provider’s recommendations and practice healthy habits, like eating a balanced diet, exercising and ditching the cigarettes.

For me?

Who is this screening intended for? Dr. Al-Dadah says it’s often done on people aged 40 to 65 or people with a family history of heart disease. But, anyone can and should ask their provider about it.

“If you’re 75 and have diabetes,” for example, Dr. Al-Dadah says. “You’re going to have a lot of calcification in the arteries. But it does not signify blockages. It’s just hardening of the arteries that comes with age. But if you’re younger and have that calcification, that’s a marker for risk of heart disease and heart attack.”

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Tabacco industry made an intense effort to market methol cigarettes in Black communitites

Photo: Frank K/PEXELS

A study by Stanford Research into the Impact of Tobacco Advertising (SRITA)and the American Heart Association, found overwhelming evidence showing that tobacco companies directly target populations including Black communities, women and youth with menthol cigarettes, which make it easier to get hooked and are much tougher to quit.

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American Heart Association

DALLAS -- The massive growth in popularity of menthol cigarettes over several decades is the result of the tobacco industry’s intense and persistent targeting of Black communities, women and youth – a campaign the industry continues today with new products and marketing campaigns. These are the findings of a new research study by Stanford Research into the Impact of Tobacco Advertising (SRITA), a research unit of Stanford Medicine, and the American Heart Association, the world’s leading voluntary organization focused on heart and brain health.

The report comes as the Food & Drug Administration weighs public comments on draft rules to remove menthol cigarettes and flavored cigars from the market, and as a growing number of states and localities act to stop the sale of menthol cigarettes and other flavored tobacco products. Massachusetts and 160 localities nationwide currently restrict the sale of menthol cigarettes, in addition to other flavored tobacco products. In November, California voters will consider a ballot measure to prohibit flavored tobacco products including menthol.

“This study is a compelling addition to the overwhelming evidence showing that tobacco companies directly target populations including Black communities, women and youth with menthol cigarettes, which make it easier to get hooked and are much tougher to quit than other tobacco products,” said Rose Marie Robertson, M.D., FAHA, deputy chief science and medical officer of the American Heart Association and co-director of the Association’s National Institutes of Health/Food and Drug Administration-funded Tobacco Center of Regulatory Science. “Nearly a century of disgraceful behavior by the tobacco companies has made clear that menthol and other flavored tobacco products threaten public health and perpetuate inequities – they should no longer be sold.”

Menthol cigarettes are used by 85% of Black people who smoke and 44% of women who smoke, compared to 30% of non-Hispanic white people who smoke. More than half of teens who begin smoking start with a menthol brand. Numerous studies have shown that the cooling sensation of menthol cigarettes makes them easier to inhale deeply, which leads to a higher dose of nicotine and a stronger addiction as compared to other cigarettes.

The study finds that disproportionately high use of menthol cigarettes by Black people, women and youth, as well as others including Hispanic people (48% of Hispanic people who smoke use menthol brands), is not the result of organically evolving consumer preferences over time. Rather, it is the result of decades of high-dollar marketing campaigns explicitly targeting these populations.

The industry’s efforts continue today in a market dominated by categorical menthol brands such as Newport, Kool and Salem, which are joined by menthol extensions of major cigarette brands including Marlboro, Camel and Pall Mall. One measure of the tobacco industry’s strong emphasis on menthol is the number of menthol variants sold in the marketplace. For example, Marlboro cigarettes are sold in 11 menthol variants, including Black Menthol, Smooth Ice and Bold Ice; Camel sells 12 types of menthol cigarettes, including Crush Smooth and Crush Rich; and market leader Newport offers seven menthol variants, including Smooth, Boost and Boost Gold.

 

Tobacco companies’ recent tactics: flavor bursts, additives and greenwashing

The study finds that tobacco companies have evolved their products with capsule cigarettes, which contain a sphere of flavored liquid in the filter that when squeezed produces a burst of intense flavor. Known as “crushers,” “clickers,” “kickers,” “infusers” and “squeezers,” capsules serve as a flavor booster in menthol cigarettes and are sold on the U.S. market by Camel, Marlboro, Lucky Strike, Newport and Pall Mall.

Capsules and other innovations including infusion cards, infused paper, flavor caps and flavor stones also serve as on-demand menthol additives in unflavored cigarettes. These post-market additives enable sellers to circumvent restrictions on menthol tobacco sales. Tobacco companies also attempt to sidestep sales restrictions by offering numerous menthol and mint varieties in categories including e-cigarettes, cigarillos, chewing tobacco, snus and hookah that are currently regulated differently than traditional cigarettes.

Another new industry marketing tactic is the depiction of menthol products as “organic,” “additive free” or “plant based”. This trend, which the study calls the “greenwashing” of menthol cigarettes, continues years of tobacco industry efforts to hide the health hazards of tobacco use to the public. A federal court in 2006 found that several major tobacco companies had violated civil racketeering laws following decades of lying to the public about the health threats of smoking.

“Our report shows that since at least the 1930s, tobacco companies have systematically preyed on targeted populations with menthol cigarette promotions intended to get more people to start smoking a product that the companies know is both harmful to health and exceedingly difficult to quit,” said Robert K. Jackler, MD, principal investigator, Stanford Research into the Impact of Tobacco Advertising and Edward & Amy Sewall Professor, Stanford University School of Medicine. “By continuously rolling out new marketing campaigns and innovating their products to avoid oversight, the tobacco industry is intent on recruiting new tobacco users and continuing to threaten public health.”

 

A long history of industry targeting

The study is the result of exhaustive research of tobacco industry marketing and internal corporate correspondence since the 1930s, including company advertisements targeting specific consumer segments by skin color, gender and age over the course of decades. The study also includes excerpts from numerous internal company documents reflecting the industry’s sophisticated marketing approaches in areas including:

• Building a menthol market in Black communities – The report examines tobacco industry efforts to sell more menthol products within Black communities by deluging urban centers with menthol cigarette advertisements on billboards, buses and subways, distributing free “starter packs” and discount coupons, and featuring prominent Black athletes and entertainers in menthol advertisements in leading Black newspapers and magazines.

For example, industry documents show that Newport employees handing out samples in predominantly Black communities from a Newport van were instructed to “assertively ask people to accept samples of Newports” as part of an overall effort to “provide aggressive promotional and advertising support for the brand.” A 1981 RJ Reynolds corporate document stated that “the Black segment has been identified as the Brand’s Special Market priority” for its Salem brand.

• Seizing on menthol’s popularity among women – The report states that when tobacco companies discovered that women were early adopters of menthol brands, they responded in kind with marketing campaigns such as Kool’s “Lady, Be Cool” and Salem’s “For More of a Woman,” and with brands targeting women such as Virginia Slims (“You’ve come a long way baby”), Eve and Capri.

The Eve brand, launched in 1971 by Liggett & Myers, intentionally chose both a “feminine package design” and a “truly female name,” according to industry documents. Philip Morris Executive Larry Williams indicated that the name Virginia Slims, launched in 1968, was chosen because “most women like to think of themselves as slim.”

• Targeting youth – Internal company documents reveal a consistent focus on attracting youth smokers since the 1920s. An internal RJ Reynolds document from September 1927 states “School days are here. And that means BIG TOBACCO BUSINESS for somebody. Let’s get it. And start after it RIGHT NOW.” In other internal correspondence, companies adopted acronyms such as “YAS” (Young Adult Smokers) and “FUBYAS” (First Usual Brand Younger Adult Smokers), referring to the targets of their youth-oriented advertising campaigns.

Lorillard’s 1984 promotion plan for Newport noted that: “Newport's franchise represents the youngest demographic profile in the industry. This profile is enviable in terms of it being an ‘in’ brand, as well as insuring future viability as long as these smokers stay within the Newport franchise.” The patently youth-targeted “Alive with Pleasure” campaign established Newport as a dominant youth starter brand, the best-selling menthol brand, and the second best-selling cigarette in the U.S. after Marlboro. Internal Newport documents reflect that a primary market for Newport cigarettes was young African Americans. Newport’s 1992 brand plan revealed that the products was targeted “primarily to young ethnic adult smokers ages 18-24,” and that “the ethnic market could be a major source of new business for the brand that we plan to exploit it.”

• Financing music festivals – From the Newport Jazz Festival that began in the 1950s, to the Salem Spirit Concert Series in the 1980s, to tobacco-sponsored concert series today including Kool MIXX, Marlboro’s Vinyl Vibes and Salem’s Stir the Senses, tobacco companies continue to recruit new users across populations through music events. The Family Smoking Prevention and Tobacco Control Act prohibited music and art event sponsorships by cigarette and oral tobacco brands, but not by cigars or emerging nicotine products such as e-cigarettes and heated tobacco.
• Obfuscating the harms of smoking – For much of the last century, tobacco companies attempted to reassure a public increasingly worried about the health consequences of smoking through marketing campaigns with claims such as “More Doctors Smoke Camels,” and “Got a cold? Smoke a Kool.” Today, menthol tobacco advertising continues to include health reassurance messaging with the use of proxy terms such as “natural” and “organic” tobacco.

“Exposing the ways tobacco companies target people in disadvantaged communities with products that threaten their health is core to the American Heart Association’s commitment to battling systemic racism,” said Michelle A. Albert, M.D., M.P.H., FAHA, volunteer president of the American Heart Association, immediate past president of the Association of Black Cardiologists and Walter A. Haas-Lucie Stern endowed chair in Cardiology, professor of medicine at the University of California at San Francisco. “To promote public health and achieve health equity, we must enact proven public policies that prevent the industry from engaging in practices that have contributed to the loss of millions of lives from tobacco use.” 

Illinois' sin taxes are some of the highest in country

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by Joe Barnas, Writer
Illinois Policy

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Many New Year’s resolutions may include kicking bad habits, but even when the government tries to curb smoking, drinking and caloric intake by imposing one of the heaviest tax burdens it’s still a matter of personal choice.

Excise taxes have failed to improve Illinoisans’ health while creating an undue burden for those with the least. But lawmakers have yet to kick the habit.

If Illinoisans’ celebratory excess this holiday season is to be followed by resolution to be better next year, maybe politicians, too, need to end the bender and cut back their penchant for excise taxes.

A 2019 study from the nonpartisan Tax Foundation found Illinois captured the sixth-highest amount per capita in excise taxes during fiscal year 2016.

Excise taxes are a “tax on a specific good or activity” and include “sin taxes” such as those on alcohol, tobacco, gambling and marijuana.

In fiscal year 2016, Illinois collected an average of $788 from every person in state and local excise taxes, according to the Tax Foundation. This exceeded each of Illinois’ neighbors by at least $100 per person.

Illinois’ myriad excise taxes are compounded by those imposed by municipalities at the local level. Chicago, for example, recently levied a 9% “amusement tax” on concerts and sporting events – which it expanded to streaming services such as Netflix and Hulu.

Illinois has seen many new and increased taxes since the study, including new taxes on recreational marijuana, legal sports betting, parking garages, as well as a doubled gas tax, increased tax on e-cigarettes, a new $1 per pack fee on cigarettes, a progressive tax on gambling proceeds – and that’s at the state level alone.

Politicians use sin taxes to generate quick tax revenue while looking to curb behavior advocates deem undesirable. But those objectives are at odds with each other: If a sin tax successfully discourages residents from purchasing the item it’s been applied to, tax revenues from those products and services are expected to decline.

Meanwhile, researchers at the Urban Institute and Brookings Institution’s Tax Policy Center found that, despite Illinois’ statewide alcohol tax hikes in 1999 and 2009, the increases had no significant impact on drunk driving fatalities.

Sin taxes are also some of the least reliable revenue sources. Tax Foundation research from 2017 showed inflation-adjusted net collections from cigarette taxes demonstrate a pattern of brief revenue spikes immediately after an increase, followed by significant long-term dips. Tobacco use has steadily and significantly declined since the 1960s, so cigarette sin taxes are extremely unreliable as a revenue source. Data from the Illinois Department of Revenue shows the Prairie State’s 2012 cigarette tax hike fell more than $120 million short of projections.

In another example, promises of new revenue fell short after Illinois legalized video poker and slots in 2009 – slapping it with a tax to help fund a $31 billion infrastructure spending program. State lawmakers projected state revenues to reach $1 billion by November 2013. In reality, the state brought in less than $70 million by then. Five years later, total state revenues were supposed to rise to $2.5 billion, but state coffers only saw $1.4 billion by November 2018.

Excise taxes are also largely regressive. While well-to-do residents may not need to tighten their belts to afford high excise taxes, low-income consumers suffer most under them.

Plus, Illinois’ exorbitant alcohol and cigarette taxes will surely move border-town residents this New Year’s to cross over to neighboring states for friendlier prices. According to at least one estimate, Illinois loses up to $30 million annually on cross-border alcohol sales.

Soda taxes have proven the regressive nature of sin taxes, according to the Tax Foundation – but that didn’t stop Cook County from imposing its own highly unpopular soda tax, while exaggerating its potential public health benefits. The tax was eventually repealed following backlash.

Not only has taxing Illinoisans’ appetites failed to rescue the state from its fiscal plunge, it’s also hurt those with the least.

This new year, Springfield lawmakers should look to real pension reform instead of regressive tax hikes to fix the state’s financial problems. Illinoisans should be left to fix their bad habits at their own discretion.

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Joe Barnas is a writer at the Illinois Policy Institute, a nonpartisan research organization that promotes responsible government and free market principles. Originally published December 23, 2020.