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Published on: January 18, 2018
Effects of Heated Tobacco Products compared to Conventional Cigarettes on Cardiovascular System: A Systematic Review
Soumaya Ben Saad1, Chahida Hrizi1, Nidhal Balloumi1
1Respiratory department C. Abderahmen Mami Hospital. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Introduction:
Heated tobacco products (HTPs) are marketed as reduced-risk alternatives to conventional cigarettes, yet their true cardiovascular safety profile remains unclear. This systematic review aimed to evaluate the acute and short-term cardiovascular effects of HTPs compared to traditional cigarettes.
Methods:
A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Embase from inception to March 2024. Eligible studies included randomized controlled trials and observational studies reporting on cardiovascular outcomes in adult users of HTPs compared to conventional smokers. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Data were synthesized qualitatively; a meta-analysis was not feasible due to heterogeneity.
Results:
Five studies (n = 460 participants) met the inclusion criteria. Risk of bias ranged from low to serious, with one industry-sponsored study. Acute HTP exposure induced hemodynamic and vascular changes comparable to those observed with conventional cigarettes. Endothelial dysfunction and persistent oxidative stress were reported across studies. One study (Ikonomidis et al.) suggested a minor reduction in oxidative biomarkers with HTP use, though clinical significance was uncertain. No study assessed mid- or long-term outcomes.
Conclusions:
HTPs do not appear to offer meaningful cardiovascular benefit over conventional cigarettes in the short term. The similarity in acute harmful effects raises concern over their widespread use and marketing. These findings underscore the urgent need for independent, long-term studies assessing clinically relevant cardiovascular endpoints.
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