Short-term cardiovascular effects and puffing behavior of exclusive heated tobacco product (HTP) users: A quasi-experimental study.

Authors

Michele Davigo, Marco Scala, Alessia Turina, Alessandra Lugo, Elisa Martelli, Frederik-Jan van Schooten, Enrico Davoli, Antoon Opperhuizen, Alexander H V Remels, Reinskje Talhout, Silvano Gallus

Published in

Tobacco induced diseases. Volume 24. Epub Jul 20, 2026.

Abstract

Heated tobacco products are often marketed and perceived as less harmful than regular cigarettes, although their acute cardiovascular toxicity is unknown. In this study, the acute effect of exclusive IQOS use on several cardiovascular parameters was assessed, and compared with those of both exclusive cigarette smokers and never smokers of tobacco products. The puffing behavior of both groups of tobacco users was also characterized.
An independent quasi-experimental study was conducted in Milan, Italy, in March-June 2024. Three groups of participants - frequency matched by age and gender - were recruited: exclusive conventional cigarette smokers (n=25, CS), exclusive IQOS users (n=26, IU), and never smokers (n=27, NS). All participants were aged ≥18 years, had a body mass index between 18.5 and 25 kg/m2, did not have respiratory or cardiovascular diseases, nor were they taking medications associated with these. The acute cardiovascular impact associated with the use of a regular cigarette or IQOS was measured by comparing systolic and diastolic blood pressure, and heart rate prior to (T0) and upon (T1) product consumption. Video-assisted measurement of the total length of the smoking session, number of puffs, puff duration, and inter-puff interval was carried out.
The mean heart beats per minute of conventional cigarette (87.4 at T1 vs 74.6 at T0) and IQOS users (86.7 at T1 vs 75.5 at T0) upon product use were higher compared with their baseline measurement (p<0.001) and with the control group (70.5 at T1 vs 74.1 at T0; p<0.001). The increases (T1-T0) in the three cardiovascular measures observed for IQOS users were not different with those of conventional cigarette smokers and significantly higher than the changes of never smokers (Δ systolic blood pressure: -5.9 in NS, 2.4 in CS and 0.3 in IU; Δ diastolic blood pressure: -1.3 for NS, 4.6 for CS and 3.1 for IU; Δ heart rate: -3.7 for NS, 12.8 for CS and 11.1 for IU). IQOS users exhibited shorter smoking sessions than cigarette smokers (4 vs 3.5 minutes, p<0.05), in which they took more frequent (16.2 s for CS, 11.8 s for IU, p<0.001) and longer puffs (1.7 s for CS, 2.3 s for IU, p<0.001).
This study shows analogous acute physiological changes of conventional and heated tobacco products on the human heart. The reported differences in puffing behaviors between cigarette and IQOS users show, to our knowledge, for the first time, the importance of using real-life puffing behavior data in laboratory settings.

PMID:
42502415
Bibliographic data and abstract were imported from PubMed on 26 Jul 2026.

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