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. 2025 Nov;46(6):443-451.
doi: 10.4082/kjfm.24.0201. Epub 2024 Dec 27.

Relationship between heated tobacco product use and low-density lipoprotein cholesterol in Korean adults: a cross-sectional study using Korea National Health and Nutrition Examination Survey 2018-2021 (VII-1 and VIII)

Myungeun Kim  1 , Kyung-Jin Lee  1 , In Choi  1 , Seung Hee Kim  2 , Kunyoung Ryu  3
Affiliations

Relationship between heated tobacco product use and low-density lipoprotein cholesterol in Korean adults: a cross-sectional study using Korea National Health and Nutrition Examination Survey 2018-2021 (VII-1 and VIII)

Myungeun Kim et al. Korean J Fam Med. 2025 Nov.

Abstract

Background: The use of heated tobacco products (HTPs) among Korean adults has been steadily increasing since they were first introduced in 2017. It is known that smoking combustible cigarettes (CCs) adversely affects the serum lipid profile and increases the risk of cardiovascular disease. However, the health impacts of HTPs remain under- researched. This study, therefore, aims to explore the effects of HTP use on serum lipid levels.

Methods: This study involved 10,309 participants, selected from the Korea National Health and Nutrition Examination Survey VII-1 and VIII conducted between 2018 and 2021. Participants were categorized based on their smoking status: "HTPs ever user" included dual, triple, and past HTP users; "current HTPs only user" for those exclusively using HTPs; "current CCs only user" for those exclusively smoking CCs; and "never smoker." Logistic regression analysis was used to assess the impact of smoking type on serum lipid concentrations.

Results: The analysis revealed that the "HTPs ever user" group had a higher odds ratio (OR) for elevated total cholesterol compared to the "never smoker" group (OR, 1.40; 95% confidence interval [CI], 1.03-1.92). The likelihood of having high low-density lipoprotein (LDL)-cholesterol was greatest in the "current HTPs only user" group when compared to "never smokers" (OR, 1.71; 95% CI, 1.01-2.89).

Conclusion: The findings indicate that exclusive use of HTPs is linked to an increased level of serum LDL-cholesterol. Further longitudinal studies are necessary to fully determine the health risks associated with HTPs.

Keywords: Dyslipidemias; E-Cigarette; Heat-Not-Burn Tobacco Product; LDL Cholesterol; Smoking.

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Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure. 1.
Figure. 1.
Odds ratios for borderline and high low-density lipoprotein cholesterol (LDL-C) compared to the never-smoker group. Statistical analysis by logistic regression analysis. HTPs, heated tobacco products; CCs, combustible cigarettes. a)Solid lines, LDL-C from 130 to 159 mg/dL. b)Dotted lines, LDL-C ≥160 mg/dL.
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