E-cigarettes and tobacco heaters – a healthier alternative or another threat. Literature review
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Praski Hospital, Department of Internal Diseases, Warsaw, Poland
Military Institute of Medicine - National Research Institute, Department of Psychiatry, Combat Stress and Psychotraumatology, Warsaw, Poland
Independent Public Specialist Western Hospital named after St. John Paul II, Department of Internal Diseases, Grodzisk Mazowiecki, Poland
Infant Jesus Clinical Hospital, University Clinical Center, Medical University of Warsaw, Department of Internal Diseases, Warsaw, Poland
Central Clinical Hospital, Department of Cardiology, Warsaw, Poland
Corresponding author
Ewa Kinga Gacoń   

Praski Hospital, Department of Internal Diseases, Aleja Solidarności 67, 03-401 Warsaw, Poland
Med Srod. 2023;26(1-2):39–42
Introduction and objective:
Nicotinism has been one of the most common addictions for many years. Tobacco smoking, both active and passive, is a serious social problem. In recent years, alternatives to conventional cigarettes have appeared on the market. The aim of the review is to analyze the latest publications available in PubMed and Google Scholar on the impact of e-cigarettes and tobacco heaters on health, in comparison with conventional tobacco products.

Brief description of the state of knowledge:
The commonly prevailing myth about the lower harmfulness of these products is being refuted more and more often. In many cases, they have a similar effect to traditional cigarettes on the organs, inter alia interfering with the functioning of the circulatory and respiratory systems. Due to the high concentration of nicotine, they can interfere with the development of the central nervous system, and their impact on fertility has also become the subject of research. It is extremely important for the health of the young generation due to the increasingly frequent use of these products by adolescents and young adults. E-cigarettes are not without impact on health and although in some aspects they may cause less organ toxicity than traditional cigarettes, it is extremely disturbing that they can lead to diseases that were not previously associated with nicotinism, e.g. by disturbing the proper functioning of the liver.

When reviewing scientific papers, many ambiguities and even contradictions in the assessment of the risk of using these products are still found. Although the overall assessment of health effects indicates their possible harmfulness, their potential use in the treatment of nicotinism cannot be overlooked.

Zdrojewicz Z, Pypno D, Bugaj B, et al. Elektroniczne papierosy: wpływ na zdrowie, nikotynowa terapia zastępcza,regulacje prawne. Pediatr Med Rodz. 2017;13(1):63–71.
Stępniowska A, Kowalczyk M, Cholewińska E, et al. E-papierosy – pomoc w rzuceniu palenia czy zagrożenie? HYG. 2017;52(2):86–95.
Zielonka T. A Debate: Can We Recommend Electronic Cigarettes to Our Patients? Opinion 1. Adv Respir Med. 2017;85:3539. https://doi. org/10.5603/ARM.2017.0007.
Kucharska M, Wesołowski W, Czerczak S, et al. Badanie składu płynów do e-papierosów – deklaracje producenta a stan rzeczywisty w wybranej serii wyrobów. Med Pr. 2016;67(2):239–253. mp.5893.00365.
Gomółka E, Radomska M, Bielska E. Ostre zatrucie płynem do e- -papierosów – opis przypadku. Prz Lek. 2016;73(10):795–797.
Holliday R, Chaffee BW, Jakubovics NS, et al. Electronic Cigarettes and Oral Health. J Dent Res. 2021;100(9):906–913. https://doi. org/10.1177/00220345211002116.
Gordon T, Karey E, Rebuli M, et al. E-Cigarette Toxicology. Annu Rev Pharmacol Toxicol. 2022;6(62):301–322. annurev-pharmtox-042921-084202.
Harrell MB, Weaver SR, Loukas A, et al. Flavored e-cigarette use: Characterizing youth, young adult, and adult users. Prev Med Rep. 2017;5:33–40.
Jones K, Salzman GA. The Vaping Epidemic in Adolescents. Mo Med. 2020;117(1):56–58.
Whanhee L, Sung-Hee H, Hayoung Ch, et al. The association between smoking or passive smoking and cardiovascular diseases using a Bayesian hierarchical model: based on the 2008–2013 Korea Community Health Survey. Epidemiol Health. 2017;22(39).
Hess I, Lachireddy K, Capon A. A systematic review of the health risks from passive exposure to electronic cigarette vapour. Public Health Res Pract. 2016;26(2).
O’Connell G, Colard S, Cahours X, et al. An Assessment of Indoor Air Quality before, during and after Unrestricted Use of E-Cigarettes in a Small Room. Int J Environ Res Public Health. 2015;12(5):4889–4907.
Montjean D, Godin Page MH, Belanger MC, et al. An Overview of E-Cigarette Impact on Reproductive Health. Life. 2023;13(3). https://
Fried N, Gardner J. Heat-not-burn tobacco products: an emerging threat to cardiovascular health. Am J Physiol – Heart Circ. 2020;319(6):1234–1239.
Uguna C, Snape C. Should IQOS Emissions Be Considered as Smoke and Harmful to Health? A Review of the Chemical Evidence. ACS Omega. 2022;7(26):22111–22124.
Fried N, Gardner J. Heat-not-burn tobacco products: an emerging threat to cardiovascular health. Am J Physiol – Heart Circ. 2020;319(6):1235–1239.
Hu H, Nakagawa T, Honda T, et al. Heated tobacco products and circulating high-density lipoprotein cholesterol concentrations. Sci Rep. 2022;12:17385.
Bhat T, Kalathil S, Leigh N, et al. Acute Effects of Heated Tobacco Product (IQOS) Aerosol Inhalation on Lung Tissue Damage and Inflammatory Changes in the Lungs. Nicotine Tob Res. 2021;23(7):1160–1167.
Pataka A, Kotoulas S, Chatzopoulos E, et al. Acute Effects of a Heat-Not- -Burn Tobacco Product on Pulmonary Function. Medicina (Kaunas). 2020;56(6):292.
Leigh N, Tran P, O’Connor R, et al. Cytotoxic effects of heated tobacco products (HTP) on human bronchial epithelial cells. Tob Control. 2018;27:26–29.
Chun L, Moazed F, Carolyn C, et al. Possible hepatotoxicity of IQOS. Tob Control. 2018;27:39–40.
Pagano S, Negri P, Coniglio M, et al. Heat-not-burn tobacco (IQOS), oral fibroblasts and keratinocytes: cytotoxicity, morphological analysis, apoptosis and cellular cycle. An in vitro study. J Periodontal Res. 2021;56(5):917–928.
Pouly S, Ng W, Benzimra M, et al. Effect of Switching to the Tobacco Heating System Versus Continued Cigarette Smoking on Chronic Generalized Periodontitis Treatment Outcome: Protocol for a Randomized Controlled Multicenter Study. JMIR Res Protoc. 2021;10(1):e15250.
Czoli Ch, White Ch, Reid J, et al. Awareness and interest in IQOS heated tobacco products among youth in Canada, England & the United States. Tob Control. 2020;29(1):89–95. 2018-054654.
Barker J, Vassey J, Chen-Sankey J, et al. Categorizing IQOS-Related Twitter Discussions. Int. J. Environ. Res. Public Health. 2021;18(9):4836.
Levine H, Duan Z, Bar-Zeev Y, et al. IQOS Use and Interest by Sociodemographic and Tobacco Behavior Characteristics among Adults in the US and Israel. Int J Environ Res Public Health. 2023;20(4):3141. https://
McKelvey K, Popova L, Kim M, et al. Heat-not-burn tobacco products: concerns from the Italian experience. Tob Control. 2018;27:41–47.
Dai H. Heated Tobacco Product Use and Associated Factors Among U.S. Youth, 2019. Drug Alcohol Depend. 2020;214:108150.
Dunbar M, Seelem R, Tucker J, et al. Correlates of Awareness and Use of Heated Tobacco Products in a Sample of US Young Adults in 2018–2019. Nicotine Tob Res. 2020;22(12):2178–2187. https://doi. org/10.1093/ntr/ntaa007.
Auer R, Concha-Lozano N, Jacot-Sadowski I, et al. Heat-Not- -Burn Tobacco Cigarettes: Smoke by Any Other Name. JAMA Intern Med. 2017;177(7):1050–1052. 2017.1419.
Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med. 2013;368:341–350.
Li J, Hui X, Fu J, et al. Electronic cigarettes versus nicotine-replacement therapy for smoking cessation: A systematic review and meta-analysis of randomized controlled trials. Tob Induc Dis. 2022;20:90. https://doi. org/10.18332/tid/154075.
Brown J, Beard E, Kotz D, et al. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction. 2014;109(9):1531–1540.