Tobacco habit represents the leading preventable cause of morbidity and mortality worldwide with a significant impact on all phases of the atherothrombotic disease process finally leading to cardiovascular (CV) events. The devastating cardiovascular complications involve children and adults.
Children exposed to passive cigarette smoking have a higher risk to develop CV events in adulthood; oxidative stress generated by cigarette smoke increases CV events through endothelial dysfunction, increased intimal-medial thickening (IMT) and platelet (PLT) activation.
Heat-not-burn cigarettes (HNBC) (IQOS trade mark, Philip Morris Inc.) are considered a preferable alternative to conventional cigarettes due to the lack of combustion and the absence of combustion correlated specific toxicants. It is unclear the long-term vascular safety of HNBC. Furthermore, no study reported the effect of HNBC passive smoking in children.
To analyze these issues, in this research we want:
1) compare the chronic impact of HNBC vs traditional tobacco cigarettes on endothelial function, oxidative stress and PLT activation in healthy adult smokers
2) compare endothelial function, oxidative stress and PLT activation in children exposed to passive HNBC smoking vs passive cigarette smoking and controls.
In the first phase we will performed an observational study in 60 healthy subjects: 20 self-reporting chronic use of HNBC, 20 self-reporting chronic use of traditional cigarettes and 20 non-smokers. For each subject blood samples for oxidative stress and PLT activation analysis and flow-mediated dilation (FMD) evaluation will be performed.
In the second phase of the study 60 children: 20 exposed to HBNC, 20 to passive cigarette smoking and 20 not-exposed. All the children will undergo to FMD and blood analysis to test endothelial function,oxidative stress and PLT activation.
This project is novel and innovative.
Previously, our research group showed the acute effects on oxidatieve stress, endothelial function and platelet activation after e-cigarettes and HNBC smoking in adults (see Impact of Tobacco Versus Electronic Cigarette Smoking on Platelet Function. Nocella C, Biondi-Zoccai G, Sciarretta S, Peruzzi M, Pagano F, Loffredo L, Pignatelli P, Bullen C, Frati G, Carnevale R. Am J Cardiol. 2018 Nov 1;122(9):1477-1481. doi10.1016/j.amjcard.2018.07.029. Epub 2018 Aug 3. PMID: 30170691; Acute Impact of Tobacco vs Electronic Cigarette Smoking on Oxidative Stress and Vascular Function.
Carnevale R, Sciarretta S, Violi F, Nocella C, Loffredo L, Perri L, Peruzzi M, Marullo AG, De Falco E, Chimenti I, Valenti V, Biondi-Zoccai G, Frati G. Chest. 2016 Sep;150(3):606-12. doi: 10.1016/j.chest.2016.04.012. Epub 2016 Apr 22. PMID: 27108682 and Acute Effects of Heat-Not-Burn, Electronic Vaping, and Traditional Tobacco Combustion Cigarettes: The Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking ( SUR - VAPES ) 2 Randomized Trial.
Biondi-Zoccai G, Sciarretta S, Bullen C, Nocella C, Violi F, Loffredo L, Pignatelli P, Perri L, Peruzzi M, Marullo AGM, De Falco E, Chimenti I, Cammisotto V, Valenti V, Coluzzi F, Cavarretta E, Carrizzo A, Prati F, Carnevale R, Frati G. J Am Heart Assoc. 2019 Mar 19;8(6):e010455. doi: 10.1161/JAHA.118.010455. PMID: 30879375).
In these studies, each participant smoked a conventional cigarette then returned 1 week later to vape a study E-cigarette (with the same nominal nicotine content) or IQOS.
In these studies we demonstrated that after smoking only one traditional, electronic or IQOS cigarette, the subjects had increased oxidative stress, platelet activation and endothelial dysfunction that can provoke serious cardiovascular damage.
However, these studies and other studies published in literature did not analyze the cardiovascular effect by endothelial and platelet function, oxidative stress and antioxidant markers in chronic smokers of HNBC.
This study could give pivotal information assessing these markers in chronic HNBC smokers and could contribute to light new perspectives for future studies about the possible cardiovascular damage of these smoking products, that could be responsible of increased cardiovascular mortality, myocardial infarction or stroke.
Another important and still unknown point is represented by the potential damage of electronic cigarettes and HNBC in exposed children.
Previously we demonstrated that children exposed to passive smoking have an increased endothelial damage and an increased oxidative stress that could affect the cardiovascular risk in adulthood (see Role of NADPH oxidase-2 and oxidative stress in children exposed to passive smoking. Loffredo L, Zicari AM, Occasi F, Perri L, Carnevale R, Angelico F, Del Ben M, Martino F, Nocella C, De Castro G, Cammisotto V, Battaglia S, Duse M, Violi F. Thorax. 2018 Oct;73(10):986-988. doi: 10.1136/thoraxjnl-2017-211293. Epub 2018 Feb 15. PMID: 29449441 and Passive Smoking Exacerbates Nicotinamide-Adenine Dinucleotide Phosphate Oxidase Isoform 2-Induced Oxidative Stress and Arterial Dysfunction in Children with Persistent Allergic Rhinitis. Loffredo L, Zicari AM, Occasi F, Perri L, Carnevale R, Battaglia S, Angelico F, Del Ben M, Martino F, Nocella C, Farcomeni A, De Castro G, Duse M, Violi F. J Pediatr. 2018 Nov;202:252-257. doi: 10.1016/j.jpeds.2018.06.053. Epub 2018 Aug 29. PMID: 30172425).
To the best of our knowledge, no study analyzed the effect of passive electronic cigarettes or HNBC smoking in children on FMD, platelet, oxidative stress and antioxidant status. Currently there are no bans on smoking electronic cigarettes indoors or near children because they are considered harmful by many parents. The results of this study could be of fundamental importance if they show damage from electronic cigarettes in exposed children.