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. Harmfulcomponents contained in HTP tobacco aerosol are in lower amounts than those in smoke from traditionalcigarettes. 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 notbe as safe as the industries claim. This review was completed to summarize effects of HTP on user’shealth, in particular on cardiovascular system.Methods: A systematic search of the literature in PubMed database was performed to identify significantarticles published from 2015 to 2021. For this review we selected randomized clinical trials that explorethe effects of heat-not-burn cigarettes on the cardiovascular system. Independent and sponsored studiesby the tobacco industry were included.Conclusion: The analysis of biomarkers of biological effect, such as those for oxidative stress, plateletactivation, endothelial dysfunction, inflammation, antioxidant reserve and others showed differencesbetween smokers and people using heated tobacco products in favor of the latter. However, studiescomparing the acute effects of different tobacco products on arterial stiffness, heart rate and myocardialfunction indicated no relevant differences between IQOS and traditional cigarettes.So, Heated Tobacco Products appear less harmful. Nevertheless, due to conflicting information andthe restricted knowledge of IQOS exposure, further long-therm human studies are needed to assess thepotential benefit and risk of heated tobacco products.