A new study suggests that switching from traditional cigarettes to heated tobacco products (HTPs) or electronic cigarettes may have less harmful effects on blood vessels than regular cigarettes, preventing artery disease. Dr. Kallirrhoe Kourea, a cardiologist at Atikon Hospital, shared the findings during the 7th Summit on Tobacco Harm Reduction: Novel Products, Research & Policy.
Dr. Angelo Hatzakis, co-chair of the research study
The research focused on the impact of cigarettes and alternative smoking products on the endothelial glycocalyx—a protective layer of cells that lines blood vessels and plays a critical role in preventing atherosclerosis or plaque buildup in the arteries.
While further research is needed, the study suggests these alternatives may be a healthier option for individuals looking to quit smoking. It showed that e-cigarettes had a neutral effect on blood vessels, while heated tobacco showed slight improvements in larger vessels.
Heated tobacco products, also referred to as heat-not-burn products (HNBs), are innovative devices that heat, without burning, specially designed tobacco sticks. Unlike traditional cigarettes, HTPs do not produce smoke or ash, which contain thousands of harmful chemicals. A well-known HTP brand in the Philippines is IQOS, which has been available in the country since 2020.
"Our findings suggest that switching from conventional cigarettes to heat-not-burn (HNB) or e-cigarettes may have beneficial effects on the cardiovascular system," Dr. Kourea said. "While previous studies have shown that HNB and e-cigarettes contain fewer harmful chemicals than traditional cigarettes, the long-term impact on blood vessel health remains unclear."
Dr. Lorenzo Mata Jr., president of Quit For Good, a Philippines-based non-profit promoting harm reduction, commented on the study’s implications. He said the primary health risks associated with smoking come from toxic substances produced during combustion, not from nicotine itself.
"Smoke-free products like HTPs offer less harmful options for consumers who can't quit tobacco consumption," Dr. Mata said.
The Greek study involved 150 participants, including 50 current smokers randomized to use either heated tobacco or e-cigarettes and 50 control smokers. The researchers monitored changes in the endothelial glycocalyx using a device that measures capillary diameters and perfused boundary regions.
The study showed that continued use of traditional cigarettes led to further deterioration of the endothelial glycocalyx, while participants who switched to e-cigarettes experienced no significant change, and those who switched to heated tobacco saw modest improvements.
The study was presented during the session “The Case of Nicotine Use in Greece – Behavioral and Clinical Data,” chaired by Dr. Angelos Hatzakis and Dr. Ignatios Ikonomidis.
"These findings highlight the potential cardiovascular benefits of alternative smoking products," said Dr. Ikonomidis, a professor of cardiology in Greece. "While more research is needed, our results suggest that HNB and e-cigarettes may be a less harmful option for smokers looking to quit."
Dr. Ikonomidis also cited preliminary findings from a multicenter study conducted in 37 countries across Europe showing positive effects on markers of lung function and arterial elasticity.
These findings are consistent with data from the Cochrane database, which reported no adverse cardiac events among heated tobacco users over a two-year period.
"Although nicotine levels were similar among users of combustible cigarettes, e-cigarettes, and HNB products, the damage was observed only in smokers of combustible cigarettes," Prof. Ikonomidis said. "This suggests that the toxic substances in cigarette smoke, not nicotine itself, are responsible for the harm."
Dr. Hatzakis stressed the need for more clinical and laboratory research on biomarkers, with a focus on long-term studies. "This is a very interesting study that opens the door for using various biomarkers to assess long-term effects and their association with clinical conditions," he said.
SCOHRE, an organization that recognizes harm reduction as a means to improve lives, organized the summit.