Dr. Farsalinos on AHA study linking HnB use to Heart Disease

Research conducted by the AHA exposed mice to aerosol emitted by Heat-not-Burn (HnB) device iQOS, and claimed that this aerosol had the same negative effects on Flow-Mediated Dilatation (FMD), as cigarette smoke. FMD is a noninvasive method to measure one’s level of endothelial function or dysfunction. “Using heat-not-burn products may not avoid the adverse cardiovascular effects of smoking cigarettes”, concluded the study Abstract.

Missing details in the study Abstract

Dr. Farsalinos who is a Research Fellow at Onassis Cardiac Surgery Center in Athens, explained that this study is creating unnecessary alarm as “FMD (and other measures of vascular function) have no prognostic value when measured after an acute exposure”, whilst adding that some critical information has been left out of this abstract.

In fact, this missing information can be found on the study’s poster said Farsalinos, as it mentions that for “the same exposure in terms of duration and puff number, iQOS delivered 4.5 times MORE nicotine to the mice compared to tobacco cigarettes”.

The study subjects were exposed to unequal levels of HnB aerosol and cigarette smoke

The public health expert explained that this equates to comparing exposure to the tobacco cigarette resulting in 15 ng/mL plasma nicotine levels, versus exposure to the IQOS resulting in 70ng/mL plasma nicotine levels, clearly creating “two fundamental problems with this study, which makes the conclusions of the abstract and press statement problematic.”

Farsalinos explained that for this study to be valid it would have been crucial to compare equivalent exposures of the cigarette smoke, and HnB aerosol. Secondly, “the fact that iQOS delivered so much higher nicotine levels compared to the tobacco cigarette is not only bizarre but also contrary to all available evidence,” added the anti-smoking activist.

iQOS was previously found to contain lower levels of nicotine than cigarettes

Last June, Farsalinos and his team published a study which looked at the nicotine levels found in the aerosol of heat-not-burn (HnB) products, in comparison to the amounts found in e-cigarette vapor and cigarette smoke. The results indicated that the nicotine levels produced by the HnB products were significantly higher than those produced by the first generation cig-a-like e-cigarettes at both puff durations.

Tobacco sticks were found to contain a similar nicotine concentration to tobacco cigarettes, however the levels of nicotine delivered to the aerosol of the heat-not-burn products were found to be lower than those delivered by tobacco cigarettes.

The adverse effects on FMD were caused by nicotine

“In conclusion, the study found that iQOS has the same acute adverse effect on FMD as cigarettes when delivering 4.5 times higher amount of nicotine compared to the tobacco cigarette. This should have been the study conclusion, but this information was not even mentioned in the abstract (however, it was presented in the poster).” said Farsalinos.

The public health expert added that since most of the adverse effects on FMD were certainly caused by nicotine, which in itself carries minimal long-term risk to the cardiovascular system, “it is almost clear evidence that iQOS has a lower acute adverse effect on FMD than smoking (it would have been perfectly clear if the nicotine exposure to mice was similar).”

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