Heated tobacco at least as harmful as cigarettes in terms of respiratory and cardiovascular health

A German study compared the acute consequences on the respiratory tract and arterial stiffness of the use of heated tobacco, conventional cigarettes and electronic cigarettes. On the cardiovascular level, it concluded that the heated tobacco products IQOS and glo are similarly harmful to conventional cigarettes. The harmfulness of heated tobacco in the small airways could even be greater than that of conventional cigarettes.

Tobacco manufacturers present heated tobacco devices as less harmful alternatives to conventional cigarettes. Studies funded by these manufacturers suggest that some toxic emissions characteristic of smoked tobacco would not be present or would be less present with heated tobacco.

After measuring the acute effects of heated tobacco, conventional cigarettes and electronic cigarettes on the respiratory tract and on arterial stiffness, a team of German researchers is now casting doubt on these claims.[1].

Randomized test and measurements of biological indicators

The researchers tested and measured the reactions of the small airways (SAP) and arterial stiffness following the consumption of several tobacco and nicotine products. The participants were 17 healthy students (8 men, 7 women) with an average age of 24, all occasional smokers. They were not to consume alcohol or products containing nicotine in the 48 hours preceding the first test. Each participant tested the different products offered in a randomized manner, and at 48-hour intervals. Cardiovascular and respiratory explorations were carried out before and after each consumption.

Four types of products were evaluated: heated tobacco from two different brands (IQOS from Philip Morris International/PMI, and glo from British American Tobacco/BAT), classic cigarettes (Marlboro Gold from PMI), and electronic cigarette without nicotine (eGo, from the Dipse brand), in comparison with a control device: an electronic cigarette without e-liquid.

Impact on small airways and cardiovascular risk

The results indicate that small airway obstruction and resistance were significantly increased with heated tobacco, conventional cigarettes, and nicotine-free e-cigarettes, compared with the control device. In addition, the increase in resistance measured was greater, although not significantly, with heated tobacco than with conventional cigarettes. This observation, in line with the results of other independent observations, is important because increased airway resistance is an early marker of chronic obstructive pulmonary disease (COPD). These diseases are very often due to the consumption of conventional cigarettes, which can lead to respiratory failure.

On the cardiovascular level, heart rate and systolic blood pressure – both central and peripheral – increased significantly with the three nicotine-containing products alone, as did total peripheral resistance. These alterations in cardiovascular function were identical between heated tobacco and conventional cigarettes. This observation is important, given that high blood pressure and arterial stiffness are risk factors for hypertension and cardiovascular mortality.

An identical, or possibly even greater, risk of heated tobacco compared to conventional cigarettes, on respiratory and cardiovascular health

Knowing that conventional cigarettes are a major cause of often fatal respiratory and cardiovascular diseases, and taking into account their observations made from predictive markers of the occurrence of these two types of pathologies, the researchers conclude that they have not observed any scientific argument in favor of a possible reduction in the risks that the consumption of heated tobacco would bring, in comparison with that of conventional cigarettes. Finally, they emphasize the interest of using electronic cigarettes without e-liquid as a control device.

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