Impact of Heated Tobacco Products, E-Cigarettes, and Combustible Cigarettes on Small Airways and Arterial Stiffness

Abstract

Smoking cessation is difficult but maintaining smoke-free without nicotine replacement therapy is even harder. During the last few years, several different alternative products, including heated tobacco products (HTP), have been introduced to the market. In this study, we investigated the acute effects of IQOS^TM and glo^TM (two HTP) consumption on small airway function and arterial stiffness in a head-to-head design, comparing them to combustible cigarettes, nicotine-free e-cigarettes and a sham smoking group. Seventeen healthy occasional smokers were included in a single-center, five-arm, crossover study. The parameters of small airway function and hemodynamics were collected at several time points before and after consumption using Mobil-O-Graph™ (I.E.M., Stolberg, Germany) and TremoFlo^® c-100 (THORASYS Thoracic Medical Systems Inc., Montreal, QC, Canada). Small airway obstruction and resistance were both significantly increased after the consumption of cigarettes and substitute products. All products containing nicotine led to similar significant increases in blood pressure and arterial stiffness. Hemodynamic parameters were also increased after the consumption of e-cigarettes without nicotine, but compared to nicotine-containing products, the increase was shorter and weaker. We conclude that, although it has yet to be determined why, HTP have acute harmful effects on small airway function, possibly even exceeding the effects of combustible cigarettes. Like other nicotine-containing products, HTP leads to a nicotine-related acute increase in arterial stiffness and cardiovascular stress, similar to combustible cigarettes, which associates these products with an increased cardiovascular risk.

Keywords: GLO; IQOS; arterial stiffness; central blood pressure; e-cigarette; heated tobacco products; nicotine replacement therapy; occasional smoking; small airway function; smoking cessation.

Figure 1

Flowchart and study design for each test person. Study design for each test person. Randomization is performed on day 1, determining the order of the test devices. Every device is tested once.

Figure 2

R5 (Central obstruction): R5 as a marker of central obstruction is displayed over time. Values are normally distributed. t-tests were performed, comparing each value to the baseline value (−10 min) of the respective group.

Figure 3

R5–R19 (Peripheral obstruction): R5–R19 as a marker of peripheral obstruction is displayed over time. Values are normally distributed. t-tests were performed, comparing each value to the baseline value (−10 min) of the respective group.

Figure 4

AX (Reactance area): Reactance area is displayed over time. Values are normally distributed. t-tests were performed, comparing each value to the baseline value (−10 min) of the respective group.

Figure 5

Tidal volume: Tidal volume is displayed over time. Values are normally distributed. t-tests were performed, comparing each value to the baseline value (−10 min) of the respective group.

Figure 6

(A) Peripheral and (B) central systolic blood pressure. Peripheral and central systolic blood pressure are displayed over time. Values are normally distributed. t-tests were performed, comparing each value to the baseline value (−10 min) of the respective group. One-way ANOVA was performed to detect significant differences between groups at the respective time.

Figure 7

(A) Central diastolic blood pressure (B) central pulse pressure. Central diastolic blood pressure and pulse pressure are displayed over time. Values are normally distributed. t-tests were performed, comparing each value to the baseline value (−10 min) of the respective group. One-way ANOVA was performed to detect significant differences between groups at the respective time.

Figure 8

Heart rate: Heart rate is displayed over time. Values are normally distributed. t-tests were performed, comparing each value to the baseline value (−10 min) of the respective group. One-way ANOVA was performed to detect significant differences between groups at the respective time.

Figure 9

(A) Augmentation index adjusted at heart rate of 75 bpm and (B) total peripheral resistance. Augmentation index and total peripheral resistance are displayed over time. Values are normally distributed. t-tests were performed, comparing each value to the baseline value (−10 min) of the respective group. One-way ANOVA was performed to detect significant differences between groups at the respective time.