Original article

Analysis of the effects of heat-not-burn tobacco product use on cardiorespiratory symptoms in adults

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Abstract

Aim: To determine if heat-not-burn (HNB) tobacco products are a safe alternative to cigarette smoking by inducing decreased decline of cardiorespiratory function. 

Methods: A clinical observational, cross-sectional study was conducted in the period between February and June 2025. It analysed and identified the effects of HNB tobacco products on cardiorespiratory symptoms in 60 adults below 55 years of age with confirmed arterial hypertension, 30 in the HNB users group (≥6 months of HNB use and no history of conventional cigarette use (CCU)), and 30 in the non-HNB user group (no history of HNB or CCU). 

Results: The gender distribution among the groups was similar. HNB tobacco product users reported significantly more respiratory (daily and nighttime shortness of breath, coughing) and cardiologic symptoms (choking, shortness of breath during physical activity). The following parameters were significantly reduced in the HNB tobacco product users: forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and forced expiratory flow at 75% (FEF75) (p = 0.01), SO₂ (p < 0.001), pO₂ (p = 0.001), HCO₃⁻ (p < 0.001), total cholesterol (p = 0.001), and basophils (p < 0.001), while the following parameters were significantly increased in the same group: right ventricular systolic pressure (RVSP) (p = 0.002), hsCRP (p < 0.001), monocytes (p < 0.001), eosinophils (p < 0.001), D-dimer (p < 0.001), and platelet count (p = 0.003).

Conclusion: HNB tobacco product use in adults with arterial hypertension was associated with worse cardiorespiratory symptoms, impaired pulmonary function, signs of early right ventricular dysfunction, and systemic inflammation. 

Keywords: cardio-respiratory symptoms, heat-not-burn products