Heated tobacco products: A reduced-risk revolution or a new public health threat?

Heated tobacco products (HTPs) are nicotine-delivery devices that heat tobacco below 350 °C and have gained popularity since their introduction on the European market, especially among smokers, ex-smokers, and young never-smokers. Sales surged by over 1000% between 2018 and 2020 in several European countries. Although marketed as less harmful than cigarettes, evidence supporting reduced health risks is limited, and little data exist on their chronic toxicity.

This thesis characterizes HTP toxicity through a human exposure study, in vitro pulmonary assays, and chemical characterization of HTP emissions. Single use of HTP substantially increases heart rate and blood pressure, as does cigarette smoking. HTP emissions inhibit cell division, activate Chronic Obstructive Pulmonary Disease-related pathways, generate reactive oxygen species, and cause DNA damage in vitro. Moreover, HTP emissions contains many of the same tobacco-associated toxins found in cigarette smoke, albeit at lower levels. Overall, HTPs may cause comparable cardiovascular and pulmonary harm as cigarettes, highlighting the need for stronger regulation and public awareness over the harmfulness of these products.