The tobacco companies have been aggressively promoting heated tobacco products (HTP), including Philip Morris IQOS, BAT’s glo and JTI’s Ploom, as safer alternatives to cigarettes as part of the companies’ efforts to reposition themselves as “part of the solution” to the tobacco problem. Similar to e-cigarettes, they argue that these products are safer because the generate the nicotine aerosol by heating a tobacco stick without setting it on fire and so avoid many toxic combustion products produced by burning the tobacco in a cigarette.
As with e-cigarettes, the problem with this argument is that it assumes that HTPare like a cigarette without the combustion products when, in fact, they are a different product that produces less of some toxicants than a cigarette and more of others. For example data PMI submitted to the US FDA as part of its successful application for permission to market IQOS in the US showed, “All substances in PMI’s list of 58 constituents (PMI-58) were lower in IQOS emissions compared with mainstream smoke of 3R4F reference cigarettes. However, levels of 56 other constituents, which are not included in the PMI-58 list or FDA’s list of [Harmful and Potenitally Harmful] HPHCs, were higher in IQOS emissions; 22 were >200% higher and seven were >1000% higher than in 3R4F reference cigarette [a standard research cigarette] smoke.“
Thus, such biomarkers produce at best a limited and potentially biased view of health risks of using HTP. As with e-cigarettes, the important measure of risks is actual health effects. Yongho Jee and colleagues from South Korea and the US just published an important new study, “The effect of heated tobacco products on metabolic syndrome: A cohort study,” showing that nonsmoking Korean people who used HTP experienced elevated risk of metabolic syndrome even higher than among Korean smokers.
Metabolic syndrome consists of having at least three of the following: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, or low serum high density
lipoprotein.
They recruited people who attended the Korea Medical Research Institute for health checkups in 2019 and who did not have metabolic syndrome at that time and followed them forward in time to 2020, when they returned for another checkup. They also recorded cigarette, e-cigarette and HTP use.
They quantifies the association of using HTPs with risk for metabolic syndrome controlling for age, sex, exercise, drinking history, and smoking regular cigarettes and using e-cigarettes, with the Cox proportional hazards model. The risk of incident metabolic syndrome was increased by 68% (HR=1.68; 95% CI: 1.25-2.26) for current HTP users compared to never users. Among HTP users who did not currently smoke conventional cigarettes, the risk was doubled (HR=2.17; 95% CI: 1.31-3.62) when their smoking duration was ≥3 years. The risk of metabolic syndrome increased by 33% (HR=1.33; CI: 1.18-1.49) among HTP users who used them more than 16 times a day. The use of HTP was found to increase the risk of developing metabolic syndrome, with a particularly elevated risk observed among those who used HTPs for more than three years. The risk was higher than that observed in conventional cigarette users.
The bottom line: This paper provides direct evidence that, contrary to the assumption based on a limited number of biomarkers of exposure that HTP are less dangerous than combusted e-cigarettes, direct evidence based on actual disease shows that HTP pose higher risks for metabolic syndrome that smoking cigarettes.
Policy makers and regulators need to stop accepting industry assertions that these prducts represent harm reduction. They don’t.
Here is the abstract:
Introduction: Evidence concerning the health effects of using heated tobacco products is needed. The aim of the present study is to investigate the effects of conventional cigarettes (CCs), electronic vaping cigarettes (EVCs), and heated tobacco products (HTPs) on the development of metabolic syndrome.
Methods: We conducted a cohort study in South Korea using data from the Korea Medical Institute. The study included 183870 people who visited the Korea Medical Institute, responded to a smoking status questionnaire in 2019, and were followed up in 2020 – ever and current use of CCs, EVCs, and HTPs. We defined the main outcome as incident metabolic syndrome among participants with at least two health checkups separated by a follow-up period of at least a year.
Results: The association of using HTPs with risk for metabolic syndrome was estimated after controlling for age, sex, exercise, drinking history, and smoking regular cigarettes and using EVCs, with the Cox proportional hazards model. The risk of incident metabolic syndrome was increased by 68% (HR=1.68; 95% CI: 1.25-2.26) for current HTP users compared to never users. Among HTP users who did not currently smoke conventional cigarettes, the risk was doubled (HR=2.17; 95% CI: 1.31-3.62) when their smoking duration was ≥3 years. The risk of metabolic syndrome increased by 33% (HR=1.33; CI: 1.18-1.49) among HTP users who used them more than 16 times a day. The use of HTP was found to increase the risk of developing metabolic syndrome, with a particularly elevated risk observed among those who used HTPs for more than three years. The risk was higher than that observed in conventional cigarette users.
Conclusions: Our findings indicate that HTP use poses comparable risks in relation to metabolic syndrome development.
The full citation is: Jee Y, Shin SY, Ryu M, Samet JM. The effect of heated tobacco products on metabolic syndrome: A cohort study. Tob Induc Dis. 2024 Dec 16;22. doi: 10.18332/tid/194490. PMID: 39687080; PMCID: PMC11647454. It is available here.
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