Ditching combustible cigarettes in favor of heated tobacco products (HTPs) may help prevent plaque buildup in arteries, according to a new study.
The study, presented during the 7th Summit on Tobacco Harm Reduction: Novel Products, Research & Policy, found that transitioning from traditional cigarettes to HTPs or electronic cigarettes may have less harmful effects on blood vessels.
Dr. Lorenzo Mata Jr., president of Quit For Good, a Philippines-based non-profit promoting harm reduction, said the results of the study have broader 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.
Heated tobacco products, which heat tobacco without burning it, 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.
Dr. Kallirrhoe Kourea, a cardiologist at Atikon Hospital in Greece, said the study focused on the impact of cigarettes and alternative smoking products on the endothelial glycocalyx—a protective layer of cells that lines blood vessels.
While further research is needed, the study suggests these alternatives may be a healthier option for individuals looking to quit smoking.
Dr. Kourea said the findings suggest that switching from conventional cigarettes to heated tobacco or e-cigarettes may have beneficial effects on the cardiovascular system. “While previous studies have shown that HNB [heat-not-burn] and e-cigarettes contain fewer harmful chemicals than traditional cigarettes, the long-term impact on blood vessel health remains unclear,” she said.
HTPs are also referred to as heat-not-burn products.
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 during the summit organized by SCOHRE, an organization that recognizes harm reduction as a means to improve lives.
“These findings highlight the potential cardiovascular benefits of alternative smoking products,” said Dr. Ikonomidis, a professor of cardiology. “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 underscored 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.
