The Harm reduction associated with heated tobacco products: A systematic review and meta-analysis

  • Javed Akram Akram Medical Complex, 2B Main Gulberg, Lahore, Pakistan, 54000
  • Dr. Shehla J. Akram Akram Medical Complex, Lahore, Pakistan
  • Professor Nadia Naseem University of Health Sciences Lahore, Pakistan
  • Dr. Sheeraz Shehzad Ch Pervaiz Elahi Institute of Cardiology, Multan
  • Dr. Rana Arslan Laeeque Rafiq Institute of Health Sciences, Multan
  • Dr. Verda Ashraf Akram Medical Complex, Lahore, Pakistan
  • Dr. Ansa Akram Akram Medical Complex, Lahore, Pakistan
  • Dr. Usman E. Sheikh Akram Medical Complex, Lahore, Pakistan
  • Dr. Miland Joshi Independent Chartered Statistician, Birmingham, UK
  • Professor Khalid S. Khan
Keywords: Harm reducation, Heat-not-burn tobacco products, Cigarettes, Systematic review; Meta-analysis; Harm reduction; Heated tobacco products; Smoking

Abstract

Objective: We conducted a systematic review and meta-analysis of randomised studies in humans comparing the outcomes of switching to heated tobacco products (HTPs) versus continuing conventional tobacco smoking by burning.

Methods: We searched the electronic databases which included PubMed, Web of Science, Cochrane Controlled Trials Register, and Google Scholar from inception to May 2023. Randomised Controlled Trials (RCTs) in humans comparing HTPs with conventional burnt tobacco products were selected. Our search yielded 4817 search results, of which six RCTs (number of participants 1362, all from high-income countries) were selected. Five of the six included RCTs had low risk in four of five domains of bias; only one study had a high risk of bias in one domain. PRISMA guidelines were followed.

Results: There were 40 biomarkers of harm reduction reported categorised into six categories. One cancer biomarker (nitrosamine) and two cardiovascular biomarkers (eosinophils and total bilirubin) showed statistically significant harm reduction (total NNAL SMD=0·82, 95% CI 0·67-0·98, eosinophils SMD=0·38, 95% CI 0·12-0·65, total bilirubin SMD=0·71, 95% CI 0·28-1·31). The remaining biomarkers of harm in cardiovascular, inflammatory, metabolic, pulmonary, and renal categories showed imprecise findings.

Conclusions: In RCTs of moderate quality, some biomarkers show harm reduction associated with switching from burnt tobacco smoking to HTPs. The majority of the findings are imprecise due to the small sample sizes of the included studies. Sufficiently powered, robust RCTs targeting key harm reduction biomarkers within both upper and low-middle income country settings are required in the future.

doi: https://doi.org/10.12669/pjms.41.1.10820

How to cite this: Akram J, Akram SJ, Naseem N, Shehzad S, Rana A, Ashraf V, et al. Harm reduction associated with heated tobacco products: A systematic review and meta-analysis. Pak J Med Sci. 2025;41(1):295-301. doi: https://doi.org/10.12669/pjms.41.1.10820

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Professor Nadia Naseem, University of Health Sciences Lahore, Pakistan

Department of Histopathology, University of Health Sciences Lahore, Pakistan

Dr. Sheeraz Shehzad, Ch Pervaiz Elahi Institute of Cardiology, Multan

Department of Physiotherapy, Ch Pervaiz Elahi Institute of Cardiology, Multan, Pakistan

Dr. Rana Arslan, Laeeque Rafiq Institute of Health Sciences, Multan

Department of Physiotherapy, Laeeque Rafiq Institute of Health Sciences, Multan

Published
2024-12-27
How to Cite
Akram, J., J. Akram, S., Naseem, N., Shehzad, S., Rana, A., Ashraf, V., Akram, A., E. Sheikh, U., Joshi, M., & S. Khan, K. (2024). The Harm reduction associated with heated tobacco products: A systematic review and meta-analysis. Pakistan Journal of Medical Sciences, 41(1), 295-301. https://doi.org/10.12669/pjms.41.1.10820
Section
Systematic Review