Smoking harm reduction strategy: impact on target organ systems (umbrella literature review)
AbstractBackground. Despite the fact that tobacco smoking is obviously dangerous for health, millions of people continue smoking. Alternative nicotine delivery systems (ANDS) have been proposed as an alternative to conventional cigarettes. At this point in time, extremely heterogeneous results from numerous studies of ANDS are known, especially with regard to effects on the respiratory and cardiovascular systems.
The purpose of this systematic review was to find information on the health effects of ANDS to inform recommendations and treatment plans for smokers who are not motivated to quit.
The PICO question was “Are ANDS significantly less harmful than continuing smoking traditional cigarettes for smokers who are not motivated to quit?”.
Material and methods. Patients: adult cigarette smokers.
Intervention: replacement of cigarettes with ANDS.
Comparison: participants who continued smoking.
Outcomes (cardiovascular): measures of cardiovascular function including blood pressure, heart rate, carotid intima–media thickness and coronary artery calcifications, or changes in cardiovascular symptoms.
Outcomes (respiratory): changes in chronic cough, sputum, wheezing, dyspnoea, exacerbations of asthma and chronic obstructive pulmonary disease, or changes in tests including forced expiratory volume, chest radiography and computed tomography.
Because the data for this study were not homogeneous, we performed a descriptive synthesis.
The following keywords were used for the search. ANDS keywords e-cigarettes, tobacco heating systems, ANDS. The keywords for cardiovascular system were cardiovascular, circulatory and stroke.
The materials obtained were entered into Rayyan for realization and initial analysis. Articles were first excluded by headline, and where the headline was insufficient for identification, the abstract was assessed. Editorials, commentaries, letters, news articles, non-peer-reviewed studies including conference abstracts, unpublished clinical trials and preprint articles were excluded from the study. Duplicates were also removed.
All studies included a comparative analysis of participants who smoked traditional cigarettes or a before-and-after study where participants made the switch from cigarettes to ANDS. Third, the study had to provide data on cardiovascular or respiratory outcomes. All three of the above criteria must be met for the study to be included.
The realization will be a narrative synthesis. Due to the heterogeneity of the findings, we anticipate that a meta-analysis would be inappropriate.
Results. The studies we have presented suggest that there may be a positive correlation between ANDS use and the occurrence of respiratory diseases, in particular negative effects on lung physiology. At the same time, according to the analyses presented, a decrease in cardiovascular risk factors: total cholesterol, C-reactive protein, was observed when “switching to” or preferentially using ANDS.
Conclusions. No tobacco or nicotine-containing product is safe and risk-free. The data we have analyzed show that the results of studies of ANDS are inconsistent. Further short- and long-term studies of ANDS are needed to assess their impact on smokers’ health compared with smoking traditional cigarettes and to explore the potential for incorporating the results of these studies into recommendations for the prevention and treatment of tobacco-associated diseases.
According to WHO, all forms of tobacco smoking, including tobacco heating systems, are harmful. Certainly, all ANDS should be subject to the same policies and regulations that apply to all other tobacco products in terms of restricting minors’ access to the products and preventing adolescent smoking, but the concept of harm reduction by “switching” from cigarettes to ANDS may have a positive impact in improving cardiovascular disease prognosis and therefore adult smokers who are not currently motivated to quit should have access to the products.
Keywords: ANDS; cardiovascular disease; respiratory disease; smoking
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Skorodumova E.G., Obrezan A.G., Skorodumova E.A. Smoking harm reduction strategy: impact on target organ systems (umbrella literature review). [Cardiology: News, Opinions, Training]. 2024; 12 (3): 43–51. DOI: https://doi.org/10.33029/2309-1908-2024-12-3-43-51 (in Russian)
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