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

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> Little clinical research on new‐generation heat‐not‐burn cigarettes ( <jats:styled-content style="fixed-case">HNBC</jats:styled-content> ) in comparison with electronic vaping cigarettes ( <jats:styled-content style="fixed-case">EVC</jats:styled-content> ) and traditional tobacco combustion cigarettes ( <jats:styled-content style="fixed-case">TC</jats:styled-content> ) has been reported. We aimed to appraise the acute effects of single use of <jats:styled-content style="fixed-case">HNBC</jats:styled-content> , <jats:styled-content style="fixed-case">EVC,</jats:styled-content> and <jats:styled-content style="fixed-case">TC</jats:styled-content> in healthy smokers. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> This was an independent, cross‐over, randomized trial in 20 <jats:styled-content style="fixed-case">TC</jats:styled-content> smokers, with allocation to different cycles of <jats:styled-content style="fixed-case">HNBC</jats:styled-content> , <jats:styled-content style="fixed-case">EVC</jats:styled-content> , and <jats:styled-content style="fixed-case">TC</jats:styled-content> . All participants used all types of products, with an intercycle washout of 1 week. End points were oxidative stress, antioxidant reserve, platelet activation, flow‐mediated dilation, blood pressure, and satisfaction scores. Single use of any product led to an adverse impact on oxidative stress, antioxidant reserve, platelet function, flow‐mediated dilation, and blood pressure. <jats:styled-content style="fixed-case">HNBC</jats:styled-content> had less impact than <jats:styled-content style="fixed-case">EVC</jats:styled-content> and <jats:styled-content style="fixed-case">TC</jats:styled-content> on soluble Nox2‐derived peptide (respectively, <jats:italic>P</jats:italic> =0.004 and 0.001), 8‐iso‐prostaglandin F2α‐ <jats:styled-content style="fixed-case">III</jats:styled-content> ( <jats:italic>P</jats:italic> =0.004 and <0.001), and vitamin E ( <jats:italic>P</jats:italic> =0.018 and 0.044). <jats:styled-content style="fixed-case">HNBC</jats:styled-content> and <jats:styled-content style="fixed-case">EVC</jats:styled-content> were equally less impactful than <jats:styled-content style="fixed-case">TCs</jats:styled-content> on flow‐mediated dilation ( <jats:italic>P</jats:italic> =0.872 for <jats:styled-content style="fixed-case">HNBC</jats:styled-content> versus <jats:styled-content style="fixed-case">EVC</jats:styled-content> ), H <jats:sub>2</jats:sub> O <jats:sub>2</jats:sub> ( <jats:italic>P</jats:italic> =0.522), H <jats:sub>2</jats:sub> O <jats:sub>2</jats:sub> breakdown activity ( <jats:italic>P</jats:italic> =0.091), soluble <jats:styled-content style="fixed-case">CD</jats:styled-content> 40 ligand ( <jats:italic>P</jats:italic> =0.849), and soluble P‐selectin ( <jats:italic>P</jats:italic> =0.821). The effect of <jats:styled-content style="fixed-case">HNBC</jats:styled-content> and, to a lesser extent <jats:styled-content style="fixed-case">EVC</jats:styled-content> , on blood pressure was less evident than that of <jats:styled-content style="fixed-case">TC</jats:styled-content> , whereas <jats:styled-content style="fixed-case">HNBC</jats:styled-content> appeared more satisfying than <jats:styled-content style="fixed-case">EVC</jats:styled-content> (all <jats:italic>P</jats:italic> <0.05). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Acute effects of <jats:styled-content style="fixed-case">HNBC</jats:styled-content> , <jats:styled-content style="fixed-case">EVC,</jats:styled-content> and <jats:styled-content style="fixed-case">TC</jats:styled-content> are different on several oxidative stress, antioxidant reserve, platelet function, cardiovascular, and satisfaction dimensions, with <jats:styled-content style="fixed-case">TCs</jats:styled-content> showing the most detrimental changes in clinically relevant features. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Clinical Trial Registration</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">URL</jats:styled-content> : <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">http://www.clinicaltrials.gov</jats:ext-link> . Unique identifier: <jats:styled-content style="fixed-case">NCT</jats:styled-content> 03301129. </jats:p> </jats:sec>