Top Things to Know: New and Emerging Tobacco Products and the Nicotine Endgame: The Role of Robust Regulation and Comprehensive Tobacco Control and Prevention
Published: March 13, 2019
- While cigarette smoking rates have steadily declined in the US In the last few decades, it still claims approximately 480,000 lives prematurely every year.
- Behavioral Risk Factor Surveillance System (BRFSS) data, estimated that 2 million US adults without history of smoking were current e-cigarette users in 2016; the prevalence of e-cigarette use was highest among younger adults
- Studies have found that e-cig vapor is associated with initiation of cigarette smoking, lower expression of immune related genes and myocardial infarction (MI) (though in the case of MI, a causal relationship could not be established.)
- A 2018 report by the National Academies of Sciences, Engineering, and Medicine summarized the latest research on e-cigarettes and found that e-cigarette aerosol contains fewer numbers and lower levels of toxicants than combustible tobacco cigarettes, and that exposure to nicotine and toxicants from aerosolization of e-cigarette constituents depended upon the characteristics of the device and its use.
- The report concluded that e-cigarettes are not without adverse biological effects in humans, but they are likely to pose less risk than continuing to smoke cigarettes.
- In animal models, researchers have demonstrated impaired cardiovascular function associated with chronic exposure to e-cigarette vapor.
- Several newer tobacco products have entered the market; most popular among them is the JUUL, a type of e-cigarette, and while it does not emit large smoke clouds, making it optimal for discrete use, the JUUL nicotine refills (“pods”) contain as much nicotine as a pack of 20 regular cigarettes.
- Other products include:
- Hookah or waterpipes - Although direct comparisons are difficult to interpret, in comparison with a single cigarette, a single session of waterpipe typically results in greater exposure to carbon monoxide and particulate matter. Waterpipe exposes smokers to significantly higher levels of heavier and more toxic poly aromatic hydrocarbons, volatile organic chemicals, heavy metals and cadmium, all of which have been associated with cardiorespiratory injury.
- Heat-not-burn tobacco cigarettes, also called heated tobacco products such as iQOS and Ploom - these devices typically contain nicotine at concentrations similar to those in combustible tobacco cigarettes, but the levels of nicotine in the aerosols of the heat-not-burn product are usually lower than in a combustible cigarette and they deliver higher levels of nicotine than e-cigarettes at low puff duration.
- Cigars/cigarillos - Primary cigar smoking has been associated with higher risks for all-cause mortality, several cancers, coronary heart disease, and aortic aneurysms.
- Smokeless tobacco -While consistent evidence shows that cardiovascular risks are lower with use of smokeless tobacco products compared with cigarette smoking, there is evidence that long-term use of these products may be associated with a modest risk of fatal myocardial infarction and fatal stroke, suggesting that smokeless tobacco use may complicate or reduce the chance of surviving both of these events.
- The use of any tobacco product including e-cigarettes, hookah, non-cigarette combustible tobacco or smokeless tobacco has adverse effects on biological systems, although each product may differ in the extent of exposure to harmful and potentially harmful constituents and therefore the extent of cardiovascular risk imposed by use.
- Health care providers should screen for all tobacco product use and counsel regarding cessation; further research is needed on the long-term biologic effects of e-cigarettes and other newer tobacco products and the effect of dual use with combustible products.
Citation
Bhatnagar A, Whitsel LP, Blaha MJ, Huffman MD, Krishan-Sarin S, Maa J, Rigotti N, Robertson RM, Warner JJ; on behalf of the American Heart Association. New and emerging tobacco products and the nicotine endgame: the role of robust regulation and comprehensive tobacco control and prevention: a presidential advisory from the American Heart Association [published online ahead of print March 13, 2019]. Circulation. doi: 10.1161/CIR.0000000000000669.