Studies show that smoke-free alternatives may reduce smoking-related morbidity

Recent studies have shown that smoke-free alternatives to combustible tobacco may reduce smoke-related morbidity, effectively benefitting the public health by changing the global burden of diseases, caused by smoking.

Leading international and Bulgarian medical experts announced the findings during the second Tobacco Harm Reduction Media Event that took place on 28th September in Nessebar, Bulgaria as part of the 10th Scientific Conference “From Science to the Patient’s Bed”, organized by Arbilis.

“Smoking cessation prolongs people’s lives, and we have to do our best to persuade smokers to quit because smoke is harmful for all human organs and systems. About 60 percent of the smokers are willing to quit smoking after a cardiovascular event, but unfortunately, they are not able to. In addition, there is a common misconception that reducing the number of cigarettes smoked per day would reduce the risk of developing smoking-related diseases. This is not true, the risk decreases, and it decreases years after quitting, only if they fully abandon smoking,” Prof. Georgiev stated during the media event.

Professor Victor Gurveich, Vice President of the National Association for Atherosclerosis Research of the Russian Federation

More than 50 participants from about 20 countries attended the event live and online.

Prominent cardiologists, pulmonologists and toxicologists from EU and Russia took part in the media event to provide an overview of the most recent trends and scientific evidence related to smoking and tobacco harm reduction.

Health experts say smoking leads to higher heart attack and hypertension risk, but agree that the smoke-free alternatives can help to reduce the harm from tobacco.

In his presentation, Georgiev said quitting smoking is the best and most effective way to reduce cardiovascular risk.

“We can also consider harm reduction by switching to heated tobacco products and e-cigarettes”, added the Bulgarian professor from National Cardiology Hospital.

Professor Victor Gurveich, the Vice President of the National Association for Atherosclerosis Research of the Russian Federation, said smoking is the reason for 36 percent of the population to be at risk of myocardial infraction.

Gurevich said its incidence is six times higher in women and three times higher in men if they smoke a pack of cigarettes a day compared to the non-smokers.

“Quitting smoking positively impacts the cardiovascular morbidity and mortality data and is even a stronger factor than reducing the cholesterol levels and lowering blood pressure. After people stop smoking the risk of a second infarction is doubly reduced after 1 year and after 2 years this risk is the same as in non-smokers. Without any doubt, patients should stop smoking completely, but in many cases even when they are in grave danger, many of them cannot overcome their nicotine addiction,” he pointed out.

On the other hand, a Hungarian cardiologist Emil Toldy-Schedel disclosed that more than six million smokers die every day from smoking-related diseases and more than 10 percent of the deaths are of people aged 30 or more.

Toldy-Schedel added that one third of the cardiovascular deaths are due to smoking and the life expectancy of smokers is reduced by 10 years compared to that of non-smokers.

“Studies also show that the live expectancy of smokers is shortened by about 20 percent compared to that of non-smokers of different ages. This clearly indicates that something needs to be done to change the situation. The problem is that only 5 percent of the people are able to stop smoking permanently without additional help,” he said.

“More than 48 percent of the patients with coronary heart disease continue to smoke, 72 percent of the patients with peripheral arterial disease and more than 57 percent of the stroke patients continue to smoke after the stroke which is an unbelievably high percentage. Hence, we need to consider applying the tobacco harm reduction approach, because we cannot leave those patients behind,” he added.

In his contribution, an Austrian pulmonologist Dr. Wolfgang Popp said smoke-free alternatives reduce lung infections, adding that the reduced risk smoke-free alternatives may contribute to the better management of chronic respiratory diseases in smokers.

“Tobacco harm reduction in lung diseases is linked to reducing the toxic substances. Reducing carbon monoxide is also important for cardiovascular diseases. Reducing carcinogens matters as well. This results in decreased number of infections, slowing the progression of COPD and cancer, lung cancer more specifically, which is a serious problem in smokers.”

He cited Sweden, which reports only 7-8 percent smokers in its population, while at the same time there is record low cancer and cardiovascular incidence in Sweden compared to the other European countries.

According to the scientists, this is due to the use of Swedish snus – oral tobacco whose use is allowed, and which is commonly used in Sweden.

“When a smoke-free product is used and tobacco is not burnt, the cancer, and maybe COPD risk can be significantly lowered and the progression of the disease and the lung infections resulting from smoking can be slowed. The use of the tobacco heating system does not generate carbon monoxide which may bring benefits to the COPD patients and the cardiovascular patients, in particular. The effect when such products are used is immediate. Another positive effect is that 80% to 99% of many different carcinogens and toxins are reduced with the THS. This means reduced risk, reduced harm and probably future benefits if the patients use such products instead of smoking,” the professor specified when speaking of the increasingly widespread tobacco heating devices.

Prof. Georgi Momekov disclosed that harm reduction is supported by scientific evidence globally.

Momekov observed that most smokers say that they want to quit and that they are aware of the risk and harm associated with smoking.

However, they are either unable or unwilling to stop because of the nicotine which is addictive. Cigarette smoking is the most harmful form of nicotine delivery.

“Harm reduction is a political approach aimed at reducing the harm caused by risky behaviour and not simply banning the respective behaviour. Two conditions need to be met to achieve public health benefits in this context: the product to be scientifically substantiated to reduce the risk compared to smoking and to be relevant to the needs of the current adult smokers, so that they accept it and use it. The satisfaction obtained from using a tobacco heating device is comparable to that from smoking a cigarette and it delivers approximately the same amount of nicotine. Smokers would not derive the same satisfaction is they use a nasal spray, nicotine chewing gum, etc.” he noted.

Public Health England observed that the harmfulness of e-cigarettes is 95 percent lower than that of traditional combustible cigarettes, and the tobacco heating devices also reduce the exposure to harmful substances of users and bystanders compared to cigarettes, the reports of the British health agency for 2017 and 2018 point out.

Another report by the Science and Technology Committee, based on 100 evidence data, concludes that the e-cigarettes vapor does not contain tar and carbon monoxide.

“These are the most dangerous components of the cigarette smoke formed by the burning of tobacco in conventional cigarettes,” Prof. Momekov stated.

The National Institute of Public Health and the Environment (RIVM) of Netherlands also concluded in its report that although not risk free, the use of the tobacco heating systems results in 10 to 25 times lower exposure to carcinogens. This may significantly improve the risk profile compared to cigarettes.

The analyses of the Federal Risk Assessment Institute of Germany also found that the reduction of the toxins contained in the aerosol of the heating devices, is likely to result in reducing the exposure to these toxins.”

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