Heat-not-burn tobacco products and cardiovascular risk reduction: A systematic review of randomized controlled trials

Article type: Review Article

Authors: Begić, Edin^{a; b; *} | Aziri, Buena^a | Omeragić, Elma^c | Medjedović, Edin^d | Iglica, Amer^e | Stanetić, Bojan^{f; g} | Kovačević-Preradović, Tamara^{f; g} | Živanović, Željko^f | Begić, Amra^h | Janković, Slobodanⁱ | Mlačo, Nejra^j | Mladenović, Zorica^k | Badnjević, Almir^{l; m}

Affiliations: [a] Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina | [b] Department of Cardiology, General Hospital “Prim. Dr. Abdulah Nakaš”, Sarajevo, Bosnia and Herzegovina | [c] Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina | [d] Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina | [e] Clinic for Heart, Blood vessels and Rheumatism, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina | [f] Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina | [g] Department of Internal Medicine, Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina | [h] Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina | [i] Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia | [j] Health Care Centre, Visoko, Bosnia and Herzegovina | [k] Department of Cardiology, Military Medical Academy, University of Defense, Belgrade, Serbia | [l] International Burch University, Sarajevo, Bosnia and Herzegovina | [m] Genetics and Bioengineering Department, Faculty of Engineering and Natural Sciences, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Correspondence: [*] Corresponding author: Edin Begić, Department of Cardiology, General Hospital “Prim.Dr. Abdulah Nakas”, Sarajevo, 71000, Bosnia and Herzegovina. E-mail: [email protected].

Abstract: BACKGROUND: Heat-not-burn (HNB) technology by the U.S. Food and Drug Administration has been classified as a modified risk tobacco product, which can be a better option for those populations who cannot give up the habit of smoking. The outlook on the effects of these products is quite controversial in the scientific world. OBJECTIVE: To present the effect of HNB tobacco products on the cardiovascular system, with reference to the existence of possible benefits of the technology. METHODS: The literature search was conducted in PubMed/Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases, with reliance on a well-defined guiding research statement. Quality appraisal was performed using the CASP checklist for randomized controlled trials. RESULTS: The search of three databases identified 167 records, and after selection process, 25 randomized controlled trials were eligible for our study’s criteria. Twenty studies investigated the effects of HNB products on biomarkers of clinical relevance. Five studies evaluated other functional heart parameters rather than biomarkers. CONCLUSION: With HNB tobacco products, significant reductions were found in biomarkers of exposure and biological effect related to pathways involved in cardiovascular disease, including inflammation, oxidative stress, lipid metabolism, platelet function, and endothelial dysfunction.

Keywords: Tobacco products, nicotine delivery devices, cardiovascular system, risk, parameters

DOI: 10.3233/THC-220677

Journal: Technology and Health Care, vol. 31, no. 4, pp. 1457-1491, 2023