Heated Tobacco Products Research Articles

Association between heated tobacco product use and quitting combustible cigarette smoking among Korean adults.

Combustible cigarette (CC) smokers often use heated tobacco products (HTPs) to quit CC smoking; however, the role of HTPs in quitting CC smoking is uncertain. We evaluated the link between HTP use and quitting CC smoking considering the intensity of HTP use among a large nationally representative sample of Korean adults. We performed a cross-sectional study using data from the 2019 Community Health Survey in Korea. A total of 46,781 adult participants (current CC smokers and former CC smokers' < 5 years) were included and Poisson regression analysis was performed to evaluate the association between HTP use and quitting CC smoking among ever CC smokers. In ever CC smokers, compared with never HTP use, current daily HTP use was positively associated with quitting CC smoking (< 1-year; prevalence ratio (PR) = 1.63, 95% confidence interval (CI) = 1.36-1.96, 1-5 years; PR = 1.47, 95% CI = 1.36-1.60), whereas current non-daily HTP use showed an inverse association with quitting CC smoking (< 1-year; PR = 0.18, 95% CI = 0.12-0.29, 1-5 years; PR = 0.23, 95% CI = 0.17-0.31). Former HTP use was positively associated with short-term quitting CC smoking (PR = 1.38, 95% CI = 1.18-1.63), but negatively related to quit CC smoking after 1 year (PR = 0.81, 95% CI = 0.74-0.88). Daily use of HTPs appeared to be related to the increase in quitting CC smoking, but discontinuation of HTP use was significantly associated with the recurrence of CC smoking among former HTP users of 1-5 years. Among ever CC smokers, daily use of HTPs was positively associated with quitting CC smoking, but non-daily use of HTPs was inversely associated with quitting CC smoking. Former HTP use was linked to an increased likelihood of short-term quitting CC smoking but was significantly associated with CC smoking relapse after 1 year.

Evaluation and Comparison of Capillary Morphology Among Combusted Tobacco, Heated Tobacco and E-Cigarette Users

The habit of smoking in its various forms represents a significant public health concern due to its wide range of pathological effects, included the oral cavity. In recent years, alternatives to traditional cigarettes, such as heated tobacco products and electronic cigarettes, have gained popularity and are often marketed as potentially less harmful options. This study seeks to evaluate and compare the morphometric characteristics of oral mucosal capillaries in individuals who consume combusted tobacco, heated tobacco, vaporized liquid, and non-smokers. Using videocapillaroscopy, we assessed both parametric and non-parametric data from 60 patients, divided into four groups according to their smoking habits. The analysis revealed significant differences in capillary morphology among the groups. Users of combusted tobacco exhibited pronounced reductions in capillary diameter, alongside increased tortuosity and the presence of microaneurysms. These alterations are indicative of chronic inflammation and vasoconstriction, likely driven by exposure to nicotine and the high temperatures associated with combustion. Conversely, users of heated tobacco and vaporized liquid exhibited comparatively fewer vascular abnormalities, although angiogenic effects attributable to nicotine were still observable. These findings suggest that alternative tobacco products may have a comparatively lesser impact on the oral microcirculation when compared to traditional smoking. However, the potential long-term effects of these products remain unclear. Further longitudinal research is required to fully understand the risks associated with prolonged use of heated tobacco and electronic cigarettes.

Biomarkers of Exposure to Nicotine and Selected Toxicants in Individuals Who Use Alternative Tobacco Products Sold in Japan and Canada from 2018 to 2019.

Comparisons of nicotine and toxicant exposures between people who use different alternative tobacco products remain underexplored. This cross-sectional, multicountry study analyzed urinary metabolites of nicotine, tobacco-specific nitrosamines [4-methylnitrosamino-1-3-pyridyl-1-butanone (NNK)], and volatile organic compounds (acrolein, acrylamide, and acrylonitrile) among established users (n = 550) in Japan and Canada. Participants exclusively or concurrently used nicotine vaping products (NVP; Canada only), heated tobacco products (HTP; Japan only), and combustible cigarettes (CC; Japan and Canada) or abstained (Japan and Canada). All product groups showed substantial nicotine exposure. Both HTPs and NVPs exposed exclusive users to lower toxicant levels than exclusive CC use. Canadian participants who exclusively used NVPs exhibited lower NNK and acrolein exposure but higher acrylamide exposure than Japanese participants who exclusively used HTPs. Concurrent use of CCs alongside alternative products exposed users to higher toxicant levels compared with exclusive use of either alternative product. Exclusive use of alternative tobacco products results in significant nicotine exposure but substantially lower toxicant exposure compared with exclusive CC use. People who use HTPs in Japan may experience higher exposure to nicotine and certain toxicants (NNK and acrolein) than people who use NVPs in Canada. Concurrent use results suggest that partially substituting CCs with alternative products may reduce toxicant exposure but to a lesser extent than completely transitioning to alternative products. Exposure patterns between two popular alternative tobacco products differ. The overall toxicant exposure from these products is lower than from CCs, providing critical data for regulatory decisions and public health considerations.

Tobacco Heating System: a Scientific Review of the Scientific Literature on Aerosol Composition

Regulation of the concentration of toxic substances derived from tobacco products is carried out to reduce the incidence of deaths and diseases caused by the use of tobacco cigarettes, as well as to decrease attractiveness, addiction, and toxicity. In this context, modified risk tobacco products (MRTPs) have been developed to provide alternative products that have the potential to reduce the risk and harm to the population when compared to smoking conventional cigarettes. One example of an MRTP is the Tobacco Heating System (THS2.2), which, unlike conventional cigarettes, heats the tobacco instead of burning it, producing a significantly reduced amount of harmful and potentially harmful constituents (HPHCs). To review the data on the content of HPHCs in the aerosols and smoke of conventional cigarettes and those of the THS2.2 type, a critical review of scientific publications in this field was conducted from January 2015 to May 2022. The selection of scientific publications from open sources was carried out from the Scopus, Web of Science, Google Scholar, PubMed, MedLine databases, and others. A similar analysis was carried out on the information already available on the websites of Philip Morris International (PMI), Elsevier, Springer, and other relevant web resources that include information on the use of the THS2.2. After conducting a comprehensive analysis of results from both independent and industry-sponsored studies, it was noted that HPHCs are not completely eliminated from the aerosol produced by heated tobacco products (HTPs). However, the levels of these HPHCs from the PMI List of 58 Constituents (PMI-58 list) are consistently lower and significantly reduced when compared to the mainstream smoke emitted by conventional cigarettes. This suggests that while HTPs present reduced emissions of toxicants in comparison, they are not completely free from risks.

The effect of cigarette smoking and heated tobacco products on different denture materials; an in vitro study

PurposeThis study compares the effect of conventional cigarette smoke versus heated tobacco on the discoloration, surface roughness, and bacterial colonization of different oral prosthesis materials.Materials and methodsA total of one hundred and twenty disc-shaped samples made of four different denture base materials were prepared to represent different denture bases to assess the surface roughness and biofilm formation; group (CA): conventional heat-cured acrylic resin (Acrostone, Egypt), group (FA): flexible acrylic resin (Valplast International Corp, USA), group (TA): heat-cured acrylic resin reinforced with titanium nanoparticles (TA nanoparticles, Nanogate, Egypt), and group (PA): 3D printed acrylic resin (Nexdent, The Netherlands). Another sixty samples of artificial and 3D printed teeth were used to assess the color change: conventional ready-made acrylic resin teeth (Acrostone, Egypt) and 3D-printed acrylic resin teeth (Nexdent, The Netherlands). Each group was further divided according to the smoking method into three subgroups (n = 10): the no-smoking exposure group (C), the conventional smoking exposure group (CS), and the heated tobacco exposure group (HT). A custom-made smoking device was used to perform the experiment. Six hundred cigarettes/heets representing 30 days of medium smoking behavior (20 cigarettes/day) were used. The surface roughness of the disc-shaped samples was measured before and after the experiment using the JITAI8101 surface roughness tester (Beijing Jitai Tech Detection Device Co., Ltd, China), and the color parameters were assessed before and after the experiment using VITA Easyshade Advance 4.01 (VITA shade, VITA made, VITA).ResultsThe results showed that both conventional cigarette smoking and heated tobacco increased the surface roughness of the denture base disc samples. This change was statistically significant in all sample groups. Bacterial accumulation was also increased in all four denture base sample groups, with the heated tobacco causing greater bacterial accumulation than conventional cigarette smoke. Regarding the color change, conventional smoking caused a more significant color change than heated tobacco for both types of teeth used.ConclusionBoth conventional smoke and heated tobacco affect dental materials adversely. Conventional cigarette smoking caused greater surface roughness and discoloration of the samples, while heated tobacco resulted in greater bacterial accumulation of study materials.Clinical implicationsIncrease dentists’ and patients’ awareness of the effects of different types of smoke.

Comparative Assessment of Acute Pulmonary Effects Induced by Heat-Not-Burn Tobacco Aerosol Inhalation in a Murine Model

Tobacco smoking remains a major global health concern, causing preventable deaths and economic strain. Although new tobacco products such as heat-not-burn (HnB) are safer alternatives to traditional cigarettes, research on their associated risks remains limited. This study aimed to investigate the effects of HnB smoke exposure on the lungs compared to those of traditional cigarettes and the combined use of HnB and cigarettes using experiments with a mouse model. We quantitatively analyzed changes in the levels of 92 blood plasma proteins using the proximity extension assay method and observed significant changes in their levels in mice exposed to different smoke conditions; specifically, the levels of certain proteins, including Ccl20, Cxcl1, and Pdgfb, increased in the HnB smoke-exposed group, suggesting activation of nicotine pathways. Comparative analysis with traditional cigarette smoke-exposed mice further highlighted similarities and differences in their protein expression profiles. This study contributes to an improved understanding of the biological mechanisms underlying the harmful effects of alternative nicotine delivery systems and identifies potential biomarkers associated with the harmful effects of HnB smoke exposure. However, the precise impact of nicotine on the immune system may be influenced by various factors, necessitating further research.

Evaluating the Risks of Heated Tobacco Products: Toxicological Effects on Two Selected Respiratory Bacteria and Human Lung Cells

Evaluating the Risks of Heated Tobacco Products: Toxicological Effects on Two Selected Respiratory Bacteria and Human Lung Cells

Heat-not-burn technology affects plasma testosterone levels and markers of inflammation, oxidative stress in the testes of rats.

Heating tobacco products (HTPs) are advanced electronic cigarette models. Classified by the FDA as a modified-risk tobacco product and can be used as part of efforts to quit smoking. Using heat-not-burn (HnB) technology, these devices heat tobacco avoiding complete combustion. Although the levels of toxicants in the mainstream are significantly lower than those observed in tobacco smoke, some recent studies have raised concerns about potential health risks associated with their use, particularly regarding their effects on male gonadal function, which remain largely unexplored. Adult male Sprague-Dawley rats were exposed, whole body, 5 days/week for 4 weeks to HnB mainstream. The expression of the cell cycle regulators Bax/Bcl-2 ratio is not affected, along with no changes in p-38. On the other hand, an increase in oxidative stress markers, including those associated with DNA damage, was observed in exposed animals, along with the induction of NF-kB dependent pro-inflammatory mediators: TNF-α, IL-1β, IL-6 and COX-2. Furthermore, inactivation of key androgenic enzymes, such as 3β-hydroxysteroid dehydrogenase and 17β-hydroxysteroid dehydrogenase, together with decreased testosterone synthesis suggest a potential impairment of male gonadal function. The results indicate that animals exposed to HnB smoke show higher levels of oxidative stress markers, including those associated with DNA damage, as well as higher levels of pro-inflammatory cytokines. The impairment of some androgenic key enzymes and those related to the activity of seminiferous epithelium, together with the decrease in testosterone levels, suggest an impairment of gonadal function through the alteration of some cellular pathways typically associated with tobacco consumption.

Survey of Secondhand Smoke for 3-Year-Old Children in the Current Era of New Tobacco Products.

To investigate children's exposure to secondhand smoke and aerosols in the current era of new tobacco products. A total of 200 children were recruited from among children who had undergone health checkups for 3-year-olds at the clinic. We investigated the smoking status of their families using a questionnaire and measured urinary cotinine concentrations in their children. The children were divided into four groups based on their families' smoking status: no smokers (n = 114), exclusive combustion cigarette smokers (n = 35), both combustion cigarette and heated tobacco product smokers (n = 12) and exclusive heated tobacco product smokers (n = 39). Of the 200 children, 53 (26.5%) had detectable urinary cotinine levels. Of these, 12 (6.0%) were classified as having heavy exposure to secondhand smoke (urinary cotinine concentration ≥ 5 ng/mL). Urinary cotinine concentrations among children living with exclusive heated tobacco product smokers were significantly lower than those among children living with exclusive combustion cigarette smokers, but higher than those in children whose family members did not smoke at all. Relative to exclusive combustion cigarette smokers, exclusive heated tobacco product smokers were significantly more likely to smoke indoors. Secondhand aerosol exposure from heated tobacco products may be reduced but cannot be completely eliminated.

Prevalence of Popular Smoking Cessation Aids in England and Associations With Quit Success

A wide range of medications, noncombustible nicotine products, behavioral support, and alternative treatments are available in England to help people stop smoking. Understanding their effectiveness outside of clinical trial settings can support informed decision-making. To provide up-to-date estimates of the prevalence of different smoking cessation aids and associations with quit success and to explore moderation by socioeconomic position. This survey study used data from the Smoking Toolkit Study, a monthly cross-sectional household survey, conducted from 2006 to 2024 in England, UK. Participants were individuals aged at least 16 years who reported trying to quit smoking in the past year. Analyses were conducted from July to November 2024. The outcome variable was self-reported success in quitting smoking from the start of the most recent quit attempt up to the time of survey (hereafter, quit success). Independent variables were use (yes or no) of the following aids in the most recent attempt: nicotine replacement therapy (NRT), obtained via prescription or over-the-counter; varenicline; bupropion; electronic cigarettes (e-cigarettes); face-to-face behavioral support; telephone support; written self-help materials; websites; smartphone apps; hypnotherapy; Allen Carr's Easyway method; heated tobacco products (HTPs); and nicotine pouches. Covariates included sociodemographic characteristics and features of the quit attempt. A total of 25 094 participants (mean [SD] age, 38.7 [15.3] years; 51.5% [95% CI, 50.8%-52.2%] men) were included. In 2023 to 2024, the most used aids were e-cigarettes (40.2% [95% CI, 37.6%-42.8%]) and over-the-counter NRT (17.3% [95% CI, 15.3%-19.2%]); 40.8% (95% CI, 38.2%-43.4%) of quit attempts were unaided. While e-cigarette use was associated with higher odds of quit success after adjustment for use of other aids and covariates (odds ratio [OR], 1.95 [95% CI, 1.74-2.17]), use of over-the-counter NRT was not (OR, 1.03 [95% CI, 0.93-1.15]). Other aids positively associated with quit success were websites (used by 4.6% [95% CI, 3.5%-5.7%] in 2023-2024; OR, 1.43 [95% CI, 1.03-1.98]), prescription NRT (used by 4.5% [95% CI, 3.4%-5.5%] in 2023-2024; OR, 1.33 [95% CI, 1.12-1.58]), varenicline (used by 1.1% [95% CI, 0.5%-1.7%] in 2023-2024; OR, 1.80 [95% CI, 1.50-2.18]), and HTPs (used by 0.7% [95% CI, 0.3%-1.1%] in 2023-2024; OR, 2.37 [95% CI, 1.24-4.51]). Face-to-face behavioral support (used by 2.2% [95% CI, 1.5-2.9] in 2023-2024) was associated with higher odds of quit success among those from less advantaged (OR, 1.59 [95% CI, 1.19-2.14]) but not more advantaged (OR, 0.91 [95% CI, 0.65-1.29]) socioeconomic positions. There was not clear evidence of a benefit of any other aid, although some analyses were inconclusive. This cross-sectional study found that while a range of effective smoking cessation aids are available in England, many people tried to quit using less effective forms of support or none at all. Quit success rates could be improved by encouraging people to use more effective methods.

Patterns of use of heated tobacco products: a comprehensive systematic review

Relative or absolute safety of heated tobacco products (HTP) remains unknown, while independent literature suggests that these products do not favour tobacco control. We conducted a comprehensive systematic review and meta-analysis to evaluate HTP usage patterns and the effect of HTP use on conventional tobacco smoking (use transitions). We used Pubmed/MEDLINE, Embase and the Cochrane Library to identify all articles published up to February 2022 on HTP use. For the present review, we included all representative cross-sectional studies dealing with HTP use, and all prospective cohort studies or cross-sectional studies on conventional tobacco smoking transitions due to HTP use. From 610 non-duplicate articles, 76 were eligible (71 cross-sectional and 5 prospective cohort studies). Compared with young adults, HTP use was less frequent among middle-aged (pooled odds ratio, OR=0.59; 95% confidence interval, CI: 0.48-0.74; number of studies, n=15) and older adults (OR=0.17; 95%-CI: 0.07-0.38; n=12). HTP use was more frequent among former (OR=2.73; 95%-CI: 1.03-7.25; n=6) and current smokers (OR=14.53; 95%-CI: 6.34-33.31; n=12). Overall, 68.3% of HTP users were dual users (n=26). Eight studies (including 5 cohorts) showed that HTP users were more likely than non-users to start conventional cigarette smoking (OR=6.31; 95%-CI: 4.13-9.65; n=2), whereas current cigarette smokers using HTPs were less likely to quit (OR=0.84; 95%-CI: 0.80-0.89; n=4). We found that HTPs are specifically popular among young generations. More than two out of three HTP users are dual users. Prospective studies consistently show that in real life HTPs are not effective smoking cessation tools.

Harm reduction associated with heated tobacco products: A systematic review and meta-analysis.

We conducted a systematic review and meta-analysis of randomised studies in humans comparing the outcomes of switching to heated tobacco products (HTPs) versus continuing conventional tobacco smoking by burning. We searched the electronic databases which included PubMed, Web of Science, Cochrane Controlled Trials Register, and Google Scholar from inception to May 2023. Randomised Controlled Trials (RCTs) in humans comparing HTPs with conventional burnt tobacco products were selected. Our search yielded 4817 search results, of which six RCTs (number of participants 1362, all from high-income countries) were selected. Five of the six included RCTs had low risk in four of five domains of bias; only one study had a high risk of bias in one domain. PRISMA guidelines were followed. There were 40 biomarkers of harm reduction reported categorised into six categories. One cancer biomarker (nitrosamine) and two cardiovascular biomarkers (eosinophils and total bilirubin) showed statistically significant harm reduction (total NNAL SMD=0·82, 95% CI 0·67-0·98, eosinophils SMD=0·38, 95% CI 0·12-0·65, total bilirubin SMD=0·71, 95% CI 0·28-1·31). The remaining biomarkers of harm in cardiovascular, inflammatory, metabolic, pulmonary, and renal categories showed imprecise findings. In RCTs of moderate quality, some biomarkers show harm reduction associated with switching from burnt tobacco smoking to HTPs. The majority of the findings are imprecise due to the small sample sizes of the included studies. Sufficiently powered, robust RCTs targeting key harm reduction biomarkers within both upper and low-middle income country settings are required in the future.

Relationship between Heated Tobacco Product Use and Low-Density Lipoprotein Cholesterol in Korean Adults: A Cross-Sectional Study Using Korea National Health and Nutrition Examination Survey 2018-2021 (VII-1 and VIII).

The use of heated tobacco products (HTPs) among Korean adults has been steadily increasing since they were first introduced in 2017. It is known that smoking combustible cigarettes (CCs) adversely affects the serum lipid profile and increases the risk of cardiovascular disease. However, the health impacts of HTPs remain under- researched. This study, therefore, aims to explore the effects of HTP use on serum lipid levels. This study involved 10,309 participants, selected from the Korea National Health and Nutrition Examination Survey VII-1 and VIII conducted between 2018 and 2021. Participants were categorized based on their smoking status: "HTPs ever user" included dual, triple, and past HTP users; "current HTPs only user" for those exclusively using HTPs; "current CCs only user" for those exclusively smoking CCs; and "never smoker." Logistic regression analysis was used to assess the impact of smoking type on serum lipid concentrations. The analysis revealed that the "HTPs ever user" group had a higher odds ratio (OR) for elevated total cholesterol compared to the "never smoker" group (OR, 1.40; 95% confidence interval [CI], 1.03-1.92). The likelihood of having high low-density lipoprotein (LDL)-cholesterol was greatest in the "current HTPs only user" group when compared to "never smokers" (OR, 1.71; 95% CI, 1.01-2.89). The findings indicate that exclusive use of HTPs is linked to an increased level of serum LDL-cholesterol. Further longitudinal studies are necessary to fully determine the health risks associated with HTPs.

Longitudinal analysis of predictors of electronic cigarette trial among adolescents in Guatemala.

Understanding factors influencing electronic cigarette (e-cigarette) trial in adolescents is crucial for shaping policies and interventions to reduce consumption and potentially prevent addictive tendencies, particularly in countries with weak regulations like Guatemala. We aimed to longitudinally assess predictors of e-cigarette trial among Guatemalan adolescents surveyed in 2019, 2020, and 2021. Students (13 to 18years old) from nine private schools completed self-administered questionnaires about e-cigarette use and associated risk factors. Data from those who had at least one follow-up survey after reporting that they had never tried e-cigarettes at either the 2019 or 2020 survey (N=838) was analyzed. We used a mixed-effects logistic regression clustered by student and school to assess predictors of ever e-cigarette use. Nearly one-quarter (21.0%) of unique students tried e-cigarettes at follow-up. Risk factors for e-cigarette trial included cigarette or heated tobacco products use (adjusted odds ratio [AOR]=2.95, 95%CI = 1.24-7.04), frequent exposure to online e-cigarette marketing (AOR=2.46, 95%CI = 1.39-4.35), alcohol or marihuana use (AOR=1.74, 95%CI = 1.17-2.58), and parental approval of e-cigarette use (AOR=1.65, 95%CI = 1.14-2.40). The perception that serious illness from life-long e-cigarette use is likely or certain (AOR=0.57, 95%CI = 0.36-0.91, and AOR=0.37, 95%CI=0.19-0.72, respectively) appeared as a protective factor for e-cigarette trial. Our findings align with international research, indicating shared risk factors across youth worldwide. The incorporation of these factors into policies and interventions targeting the reduction of e-cigarette trial is imperative for optimizing their efficacy.

E-cigarette (EC) and heated tobacco product (HTP) use in the United Arab Emirates, an emerging EC and HTP market: A cross-sectional analysis of the International Tobacco Control (ITC) UAE Survey.

E-cigarettes (ECs) and heated tobacco products (HTPs) are recent arrivals to the nicotine product market in the Middle East, which are rapidly growing in popularity in the region. There is a lack of surveillance data at the country-level on use of these products and factors associated with their use. This study analyzed a subset of data from the UAE Healthy Future Study, a population-based cohort study of the Emirati population, to determine the factors associated with EC and HTP use among a sample of Emirati adults (≥ 18 years). The baseline assessment and supplementary questionnaires, conducted from 2016 to 2023, included data on combustible tobacco use, EC, and HTP use and sociodemographic characteristics. Of the 2,041 individuals who answered questions on EC use, 32% reported ever using them. Of 521 people providing data on HTP, 30% reported ever using them. After adjusting for age, sex, education, perceived harms and perceived addictiveness of EC, current EC use was associated with baseline combustible tobacco smoking (aOR = 27.63, 95% confidence interval [CI] 14.39, 53.06), users of a younger age (aOR=0.91, 95%CI 0.88, 0.95), and users of male sex (OR = 2.15, 95% CI 1.21, 3.81). Current HTP use was less common, but was also associated with baseline combustible tobacco use. Use of ECs and HTPs was more common among those who used combustible tobacco. Future research should examine use trajectories among those who do and do not smoke, as well as uptake of these products among youth. Non-combustible nicotine products are growing in popularity in the Middle East Region. Our study found that EC and HTP use is associated with baseline combustible tobacco use and that concurrent users may use them to cut down on their combustible tobacco use. Continued comprehensive population-based monitoring of all tobacco and nicotine products, especially EC and HTP use, will provide current data to aid in appropriately informing public health and harm reduction messages and programming.

Reducing the Cardiovascular Risks of Smoking: Insights From the European Society of Cardiology (ESC) Congress 2024 and Two Key Opinion Leaders

Smoking is a major risk factor for cardiovascular disease (CVD) and responsible for around 25% of all CVD-related deaths worldwide. Cigarette combustion releases nicotine and produces thousands of chemicals, many of which are toxic. Complete cessation of smoking is the most effective way of reducing the associated CVD risk. However, many people find it difficult to quit smoking due to nicotine’s addictive nature and the ritualistic aspect of smoking. The European Society of Cardiology Congress (ESC) 2024, held in London, UK, between 30th August–2nd September, included several sessions discussing tobacco harm reduction in relation to CVD, with a particular focus on e-cigarettes and heat-not-burn products (HNBP) as alternatives to cigarettes. EMJ interviewed two key opinion leaders (KOL), who had attended ESC 2024, to obtain their insights into tobacco harm reduction in Europe: Vincenzo Montemurro, Professor and Consultant Cardiologist at the Scilla Hospital of America, Reggio Calabria, Italy; and Emil Toldy-Schedel, Professor, Consultant Cardiologist, and General Director of the St. Francis Hospital, Budapest, Hungary. Montemurro explained that switching from cigarettes to alternative products that generate fewer toxins would likely reduce CVD risk in people who are unable to quit smoking, which would benefit public health and decrease healthcare expenditure in Europe. Toldy-Schedel agreed with this view but called for well-designed studies to fully characterise the risk profile of these newer products so that healthcare professionals can be better equipped to answer patients’ questions about possible long-term effects.

The effect of heated tobacco products on metabolic syndrome: A cohort study.

Evidence concerning the health effects of using heated tobacco products is needed. The aim of the present study is to investigate the effects of conventional cigarettes (CCs), electronic vaping cigarettes (EVCs), and heated tobacco products (HTPs) on the development of metabolic syndrome. We conducted a cohort study in South Korea using data from the Korea Medical Institute. The study included 183870 people who visited the Korea Medical Institute, responded to a smoking status questionnaire in 2019, and were followed up in 2020 - ever and current use of CCs, EVCs, and HTPs. We defined the main outcome as incident metabolic syndrome among participants with at least two health checkups separated by a follow-up period of at least a year. The association of using HTPs with risk for metabolic syndrome was estimated after controlling for age, sex, exercise, drinking history, and smoking regular cigarettes and using EVCs, with the Cox proportional hazards model. The risk of incident metabolic syndrome was increased by 68% (HR=1.68; 95% CI: 1.25-2.26) for current HTP users compared to never users. Among HTP users who did not currently smoke conventional cigarettes, the risk was doubled (HR=2.17; 95% CI: 1.31-3.62) when their smoking duration was ≥3 years. The risk of metabolic syndrome increased by 33% (HR=1.33; CI: 1.18-1.49) among HTP users who used them more than 16 times a day. The use of HTP was found to increase the risk of developing metabolic syndrome, with a particularly elevated risk observed among those who used HTPs for more than three years. The risk was higher than that observed in conventional cigarette users. Our findings indicate that HTP use poses comparable risks in relation to metabolic syndrome development.

What Do We Know About Smoking Alternatives? A Study on IQOS Tobacco Heaters

IntroductionNicotine addiction poses a significant public health concern in Poland, exacerbated by smoking, e-cigarettes, and heated tobacco products. While tobacco companies claim their alternatives aid cessation, their vested interests warrant cautious scrutiny. This study examines tobacco harm reduction strategies. Aim of the StudyThis study examines IQOS tobacco heaters as a potential harm reduction alternative for smokers. Analyzing health data and regulatory findings, particularly from the FDA, it evaluates the effectiveness and public health impact of heated tobacco products within broader harm reduction strategies. Materials and MethodsThis study examined literature and data to assess IQOS and heated tobacco products' chemical and health risks. It analyzed findings to compare IQOS aerosol and cigarette smoke toxicant exposures, clarifying IQOS's nicotine profile and smoking cessation potential. ConclusionThe findings indicate IQOS may reduce certain toxin exposures compared to cigarettes, but long-term health impacts are unclear. Further research is needed on IQOS's effects, including disease, addiction, and population-level consequences. Cautious regulation is warranted due to youth risks and ethical concerns surrounding nicotine alternatives.

Catalytic Reduction of the Compounds Generated When Heating Heet Tobacco in Presence of USY and Beta Zeolites and Silica Lovel 6000 and SBA-15 Silicate in Oxidative and Inert Atmospheres: Effect of Temperature and Catalyst Content

The thermal decomposition of a heat-not-burn (HNB) tobacco at four temperatures (250–400 °C) was studied via thermogravimetric analysis (TGA) and Multi-shot pyrolizer experiments (Py-GC/MS), and the effect of four potential additives, USY Beta and beta zeolites and Silica Lovel 6000 and SBA-15 silicates at three concentrations (5, 15 and 25% w/w) under an inert and oxidative atmosphere was analyzed. Different techniques were applied showing that the presence of the additives modifies the decomposition processes (TGA). Py-GC/MS showed that these tobaccos generate large amounts of Nicotine and Glycerine. Acid compounds are the most abundant compounds under an inert atmosphere, while Oxygenated compounds predominate under an oxidative atmosphere. In both atmospheres, Furans and Aromatics present in a significant abundance at high temperatures. The additives used reduce both the number and the concentration of most of the compounds generated, especially at high temperatures and concentrations. Moreover, SBA-15 shows good aptitudes to reduce the formation of some individual compounds included in the FDA’s HPHC list, such as Acetone and Acetaldehyde. Finally, smoking experiments corroborated that all additives produce marked reductions in TPM, i.e., the majority fraction obtained, and in practically all the compounds generated. Phenol, a toxicant compound that was detected in a significant amount, is also markedly reduced. SBA-15 is the material that presents a major reduction in the TPM and the principal compounds generated. These results may be of great interest for further reducing the toxicity of smoking this type of heat-not-burn tobacco product.

The Use of Heated Tobacco and the Health Status of Young Adults in Poland- Preliminary Results

IQOS (I-Quit-Ordinary-Smoking) is the most frequently chosen heated tobacco product among young people in Poland. The study aimed to investigate the effect of IQOS on blood count parameters, biochemical biomarkers, and lipid profile, as well as to make a comparative assessment between people using IQOS, smoking traditional cigarettes, and non-smokers. This case-control study was conducted in 2022-2024 among 85 young people in Poland (Lodz voivodeship) aged 18-30: 29 people using only IQOS, 15 people smoking traditional cigarettes and 41 healthy people not using nicotine products. A 20 ml blood sample was taken and the blood count (WBC, RBC, MONO, PLT, HGB), biochemical biomarkers (CRP, uric acid, fibrinogen, apo A1, apo B, glucose), and lipid profile (total cholesterol, TG, HDL, LDL). There were no statistically significant differences (p&gt;0.05) in the level of blood count, biochemical biomarkers, and lipid profile between the three study groups. Among cigarette smokers, the uric acid level was significantly higher compared to IQOS users and non-smokers: 5.47 vs. 4.77 vs. 4.47 mg/dl (p=0.01). Among IQOS users (n=29), the level of glucose (r=-0.41; p=0.03) and uric acid (r =-0.46; p=0.01) was negatively correlated with the daily number of heated tobacco sticks. Further research is necessary to assess the impact of IQOS use on the health of young people.