What are the health risks of heated tobacco compared to traditional tobacco products?

Health Risks of Heated Tobacco Compared to Traditional Tobacco Products

Heated tobacco products are not harmless alternatives to traditional cigarettes and still pose significant health risks, though potentially reduced compared to combustible tobacco products. 1, 2

Comparison of Health Risks

Heated Tobacco Products (HTPs)

• HTPs heat tobacco to lower temperatures (around 350°C) rather than burning it at higher temperatures (900°C) like traditional cigarettes 3
• While HTPs may reduce exposure to some harmful substances compared to combustible cigarettes, they still contain nicotine and numerous toxic chemicals 3
• Several toxic compounds not detected in cigarette smoke have been reported in HTP aerosol, creating potentially new and unknown health risks 3
• More than twenty harmful and potentially harmful constituents have been reported to be higher in HTP aerosol than in cigarette smoke 3
• The long-term health effects of HTPs are not fully understood, making claims of reduced harm unsubstantiated 3, 4

Traditional Tobacco Products

• Combustible tobacco products (cigarettes, cigars, pipes) are clearly the most harmful form of tobacco use 1
• Traditional cigarettes burn tobacco at approximately 900°C, producing significantly more harmful chemicals through combustion 3
• Combustible tobacco contains polyaromatic hydrocarbons, acrolein, carbon monoxide, and particulate matter that cause immune suppression, inflammation, and tissue damage 1
• Traditional tobacco products are associated with well-documented risks of cardiovascular disease, respiratory disease, and cancer 1

Specific Health Concerns

Cardiovascular Effects

• Both HTPs and traditional tobacco products negatively impact cardiovascular health 2, 4
• HTPs can adversely affect cholesterol metabolism, though possibly to a lesser degree than traditional cigarettes 2
• Some studies show improvements in cardiovascular risk markers (cholesterol, HDL) with HTPs compared to continued cigarette smoking, but risks remain compared to non-use 5

Respiratory Effects

• HTPs may alter mitochondrial function, potentially exacerbating airway inflammation, airway remodeling, and increasing lung cancer risk 5
• HTPs have the potential to increase oxidative stress and respiratory tract infections by increasing microbial adherence to the respiratory tract 5
• Some studies show improvements in respiratory markers (FEV1) with HTPs compared to continued cigarette smoking, but risks remain compared to non-use 5

Nicotine Exposure and Addiction

• HTPs and traditional cigarettes have similar nicotine exposure levels and pharmacokinetics 6
• Both products deliver the highly addictive substance nicotine, which is harmful to adolescent brains, developing fetuses, pregnant women, and adults 3
• Use of HTPs results in nicotine dependence and may exacerbate the difficulty in discontinuing tobacco consumption 6

Clinical Recommendations

For Healthcare Providers

• Advise all patients not to use cigarettes, other tobacco products, or e-cigarettes 1
• Routinely ask about the use of all tobacco products, including HTPs, and recommend cessation 1
• If patients are using HTPs to quit smoking, advise them to avoid using both combustible and heated tobacco products simultaneously 1, 2
• For those using HTPs as a quitting method, emphasize that they should have a plan to eventually quit these products as well 1, 2

For Public Health Policy

• From a precautionary public health perspective, HTPs should be regulated similarly to traditional cigarettes until their health effects are fully elucidated 6
• Comprehensive studies addressing the safety profile related to long-term HTP use are warranted 3
• Monitor the potential gateway effect of HTPs that may lead non-smokers to nicotine addiction 6, 4

Common Pitfalls and Caveats

• Many consumers incorrectly perceive HTPs as harmless or significantly less harmful than traditional cigarettes 2, 4
• Dual use of HTPs and traditional cigarettes may amplify health risks rather than reduce them 4
• The lack of regulation and variety of products on the market make it difficult to assess specific risks associated with each device 4
• Most available data on HTPs come from tobacco industry-funded research, with limited independent studies on their health effects 3
• The long-term health impacts of HTPs remain unknown, as these products have only been widely available for a relatively short time 7, 4