Key result
Heated tobacco, e-cigarettes, and combustible cigarettes acutely increase inflammatory markers and arterial stiffness.
Why the study?
Debate exists regarding risk reduction of heated tobacco products and e-cigarettes compared to combustible cigarettes, with preliminary data indicating harmful cardiovascular effects.
Does acute use of heated tobacco products and e-cigarettes increase inflammation and arterial stiffness in young active smokers compared to baseline or nicotine-free e-cigarettes?
RCT (n=40)
Partly double-blinded (semi-blind)
randomised by drawing pieces of paper out of a closed envelope
No
Does acute use of heated tobacco products and e-cigarettes increase inflammation and arterial stiffness in young active smokers compared to baseline or nicotine-free e-cigarettes?
p-value: p=<0.05
Heated tobacco products and e-cigarettes, even without nicotine, induce acute inflammatory responses and endothelial dysfunction comparable to combustible cigarettes, suggesting an increased cardiovascular risk.
Acute use of heated tobacco and e-cigarettes raises short-term CV risk markers; extends RCT evidence of inflammation and stiffness to non-combustible alternatives.
In addition to the market launch of heated tobacco products (HTPs) and the JUUL as well as the EVALI, they caused a widespread discussion on the risk reduction compared to a combustible cigarette. Furthermore, first data showed harmful effects on the cardiovascular system. We, therefore, conducted investigations including a control group with a nicotine-free liquid. Forty active smokers were studied in two different approaches during and after consuming an HTP, a cigarette, a JUUL, or a typical electronic cigarette with or without nicotine in a partly double-blinded randomised, cross-over trial. Inflammation, endothelial dysfunction, and blood samples (full blood count, ELISA, multiplex immunoassay) were analysed, and arterial stiffness was measured. In addition to the cigarette, an increase in the white blood cell count but also in proinflammatory cytokines was shown for the various nicotine delivery systems. These correlated with the parameters of arterial vascular stiffness as a clinical parameter of endothelial dysfunction. It can be shown that even a single consumption of the different nicotine delivery system or cigarette leads to a significant inflammatory reaction followed by endothelial dysfunction and increased arterial stiffness causing cardiovascular disease. Inflammation, endothelial dysfunction, and arterial stiffness should be addressed in long-term observational studies.
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Belkin et al. (2023) conducted an RCT in Active smokers (healthy) (n=40). Heated tobacco products, e-cigarettes (with or without nicotine), and combustible cigarettes vs. E-cigarette without nicotine (used as a control arm) was evaluated on Acute changes in inflammation (white blood cell count, proinflammatory cytokines) and parameters of arterial stiffness (PWV, AIx@75) (p=<0.05). Acute consumption of heated tobacco products, e-cigarettes with or without nicotine, and combustible cigarettes led to significant increases in white blood cells and proinflammatory cytokines, which correlated with increased arterial stiffness.
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