Differential Effects of Heated Tobacco Products and Conventional Cigarettes on Cardiovascular System A Systematic Review of Randomized Trials

Abstract

Background: Heated tobacco products (HTP) are alternative forms to traditional cigarettes. Harmful components contained in HTP tobacco aerosol are in lower amounts than those in smoke from traditional cigarettes. That’s why HTP are believed to reduce the burden of smoking related-diseases. However, due to its potentially toxic chemicals and the increased concentration of nicotine, HTP devices may not be as safe as the industries claim. This review was completed to summarize effects of HTP on user’s health, in particular on cardiovascular system.Methods: A systematic search of the literature in PubMed database was performed to identify significant articles published from 2015 to 2021. For this review we selected randomized clinical trials that explore the effects of heat-not-burn cigarettes on the cardiovascular system. Independent and sponsored studies by the tobacco industry were included. Conclusion: The analysis of biomarkers of biological effect, such as those for oxidative stress, platelet activation, endothelial dysfunction, inflammation, antioxidant reserve and others showed differences between smokers and people using heated tobacco products in favor of the latter. However, studies comparing the acute effects of different tobacco products on arterial stiffness, heart rate and myocardial function indicated no relevant differences between IQOS and traditional cigarettes. So, Heated Tobacco Products appear less harmful. Nevertheless, due to conflicting information and the restricted knowledge of IQOS exposure, further long-therm human studies are needed to assess the potential benefit and risk of heated tobacco product