Smoking is one of the most aggressive risk factors for the development of most chronic noncommunicable diseases (CKD) — cardiovascular, respiratory, metabolic and oncological. Quitting a bad habit is a necessary part of their prevention and therapy, however, there is a proportion of avid smokers who are not motivated to give up, which makes it necessary to search for possible solutions to reduce toxic effects on the body. Smokeless nicotine-containing products, which Russian and foreign scientists have been conducting comprehensive research on for years, can provide an opportunity for heavy smokers to adjust their lifestyle and gradually give up a bad habit.
Change the lifestyle and modify the risk
According to Rosstat, diseases of the circulatory system, neoplasms and respiratory diseases are the three main causes of death in Russians. It has been proven that smoking is one of the key risk factors for the development of chronic non—communicable diseases - lung cancer and at least 12 other types of cancer, cardiovascular pathologies, chronic obstructive pulmonary disease (COPD) and many other diseases. For example, according to research, a smoker has a 30-40% higher risk of developing type 2 diabetes than a non—smoker, and the risk of developing pancreatic cancer is almost twice as high.
"Smoking creates a socio-economic burden on the health system and society as a whole",— it is noted in the Concept approved by the Government of the Russian Federation for the implementation of the state Policy of countering the consumption of tobacco and Other nicotine-containing products in the Russian Federation for the period up to 2035 and beyond.
To reduce morbidity and mortality from tobacco-related causes, it is necessary to seek the most comprehensive and effective measures. For a smoker, this primarily means a change in lifestyle — and here, undoubtedly, the most effective measure is a complete cessation of smoking. This is exactly the recommendation that a doctor of any specialty will give to his patient.
But what to do in cases where the smoking experience is measured in decades, and the patient cannot or does not want to quit smoking? In such cases, one way to overcome severe nicotine addiction may be to use certified alternative sources of nicotine delivery (AIDN). These include electronic cigarettes, electronic tobacco heating systems (ESTS), as well as oral types of tobacco or nicotine (snus, nicotine spiders).
According to numerous studies, cigarette smoke contains more than 7 thousand chemicals, including at least 69 carcinogens and 250 components with cytotoxic effects.
The main feature of AIDN, unlike classic cigarettes, is the absence of a burning process — and therefore toxic smoke, which is the main cause of the development of most chronic non-communicable diseases.Gorenje In this regard, the potential of smokeless tobacco products to modify risks and help heavy smokers with severe nicotine addiction is being carefully studied, including in Russia.
In 2021, the Association of Medical Risk Modification Specialists (AMSMR) was established in Russia, a community of professionals focused on solving problems related to the modification of medical risks, uniting doctors of various specialties. AMSMR experts are working on developing simple and understandable solutions to modify the main risk factors for the development of CND, such as insufficient sleep, physical inactivity, obesity, high blood glucose and lipid levels, excessive alcohol consumption and tobacco smoking. One of the important directions of the Association was the fight against the prevalence of tobacco smoking and the search for flexible solutions for unmotivated smokers through smokeless nicotine-containing products.
In March 2024, the AMSMR held an expert council on "The possibility of risk modification in patients with oncological diseases of the head and neck organs." The resolution of the expert council, published in the journal "Clinician" (No. 2, 2024), in particular, notes: "AIDN ensures that the consumer receives the amount of nicotine he needs with reduced exposure to toxic and carcinogenic substances characteristic of cigarettes… Currently, there is no convincing evidence that AIDN is more harmful than cigarettes. On the contrary, there is an extensive research base showing that for adult smokers who are not motivated to give up smoking, products that do not have a burning process can be a way to reduce the harmful effects of tobacco smoking on the body." Gorenje
One of these studies was conducted in 2018 at the All-Russian Scientific Research Institute of Tobacco, Shag and Tobacco Products (VNIITTI) in Krasnodar. VNIITTI staff conducted a comparative analysis of the chemical composition of the ESNT aerosol and the smoke of a standard 3R4F cigarette and the five best-selling cigarette brands in Russia. The analysis showed that the content of toxic components in the ESNT aerosol is significantly lower compared to cigarettes — in terms of carbon monoxide by 96-98%, benzene — more than 99%, benzene(a)pyrene — by 90-94%, 1,3-butadiene — more than 99%, NNN — by 94-98%, NNK — by 91-98%, acrolein — more than 92%, formaldehyde — by 83-91%, acetaldehyde — by 80-86%.
In 2022, the British consulting company Biochromex, engaged in health consulting, published the results of a scientific study "Assessing the relative risk of nicotine-containing products: a systematic review and meta-analysis." The analysis included a total of 123 studies. The relative risk of various types of nicotine-containing products was assessed on a 100-point scale. As a result of the analysis, a group of high-risk products (where the risk is estimated in the range from 40 to 100 points) and a group of low-risk products (risk level less than 10 points) were identified. The first group (the number of points is indicated in parentheses) included: cigarettes (100), tobacco cigarettes (99), Asian bidi cigarettes (93), cigarillos (84), hookah tobacco (66), pipe tobacco (61). ESNT and electronic cigarettes are included in the low-risk product group — they have 5 and 3 points, respectively.
Reducing the risk of developing cancer
Although the use of AIDH does not completely eliminate the risks of developing smoking—related diseases, if it is impossible for an adult heavy smoker to completely give up, AIDH can at least reduce - or, in other words, modify them.
In 2020, scientists at the N. N. Blokhin National Medical Research Center for Oncology completed a large clinical and epidemiological cohort study to study the effect of smoking cessation on the prognosis of the disease after the patient was diagnosed with lung cancer. The study, published in 2021, involved 517 patients with a confirmed diagnosis of lung cancer who were treated in 2007-2016 at the N. N. Blokhin National Research Medical Center of Oncology and the Moscow City Oncological Dispensary No. 1 and smoked at the time of diagnosis. The study showed that continued smoking after diagnosis worsens the prognosis. Whereas quitting smoking, even during the course of the disease, on the contrary, significantly improves the prognosis, reduces overall and oncological mortality, increases overall survival and progression-free survival.
The lead author of the study, President of the Cancer Society of Russia, corresponding member of the Russian Academy of Sciences David Zaridze believes that quitting smoking should be made a priority in the process of antitumor treatment. He proposes to develop "Clinical recommendations on smoking cessation for cancer patients" taking into account the tense psychological state of cancer patients. According to David Zaridze, adult smokers who cannot or do not want to give up smoking, within the framework of the risk modification concept, it is advisable to provide a less harmful, certified, scientifically based alternative — for example, electronic nicotine delivery systems (ESDS) or tobacco heating systems. Their use for many heavy smokers could be a temporary solution on the way to complete smoking cessation and an important tool to reduce the toxic load on the body.
The above-cited resolution of the expert council "The possibility of risk modification in patients with oncological diseases of the head and neck organs" notes: "Smoking cessation should become the "fourth pillar" in the treatment of cancer patients along with surgery, radiation and drug antitumor therapy." If the doctor is satisfied that the patient is not currently motivated to quit smoking, he can inform the patient about the risk modification strategy by switching to AIDN, which exclude tobacco burning. gorenje At the same time, as experts emphasize, it is important to avoid "double" smoking, which is why it is worth reminding patients of the need to completely abandon conventional cigarettes in favor of exclusively AIDN, if it is impossible to completely abandon tobacco and nicotine consumption. At the same time, when the patient is motivated to completely abandon a bad habit, it is necessary to encourage the rejection of AIDN.
Risk reduction in cardiology, pulmonology, and endocrinology
A review of scientific data on the use of AIDN in cardiology and pulmonology was published in the journal Cardiology (No.3, 2024). In particular, it says that studies evaluating the effect of exposure to ESNT on cardiovascular diseases (CVD) demonstrated an improvement in clinically significant risk markers in patients who switched to the new product compared with those in smokers who use cigarettes daily. Based on this, it can be assumed that ESNT may be a product with a reduced risk of developing diseases, including respiratory and cardiovascular diseases. The review also notes: "Epidemiological studies have shown that the probability of respiratory complications in former smokers who currently use electronic products is 40% lower than in smokers who use exclusively electronic cigarettes. At the same time, according to the presented analyses, when switching to AIDH or using them primarily, those who are not motivated to quit smoking, compared with those who continued smoking conventional cigarettes, there was a decrease in certain risk factors for CVD, in particular, levels of total cholesterol and C-reactive protein."
In 2020, a group of researchers from the Academy of Preventive Medicine (Almaty, Kazakhstan), led by Professor Almaz Sharman, completed the first stage of a long-term cohort observational study of the effect of electronic tobacco heating systems on the body of users in comparison with conventional cigarettes. The results of their work are published in the Global Journal of Respiratory Care. The study involved women and men aged 40 to 59 years. The participants were divided into two groups — one group smoked regular cigarettes, the other used electronic tobacco heating systems.
When comparing the health indicators of the participants of the two groups, made before the start of the study and a year later, the following turned out. In the COPD Assessment Test (CAT), a cohort of e—cigarette users improved their cumulative CAT scores by 40% compared to those who smoked regular cigarettes. The proportion of participants whose test showed CAT?10, which means high risk and multiple symptoms of the disease, decreased by more than 13% for ECT users and increased by more than 8% for cigarette smokers.
In addition to improving lung function, users of electronic tobacco heating systems have improved physical performance and improved some medical indicators (blood pressure, blood sugar and cholesterol levels, etc.). The authors of the study note that the results obtained may serve as evidence of the feasibility of ESNT as a less harmful alternative to conventional cigarettes — and today this study continues.
In May 2024, a meeting of the Council of Experts was held in Moscow within the framework of the National Congress of Endocrinologists "Innovative Technologies in Endocrinology" (ITE, 2024), whose task was to consider the modern possibilities and importance of treating tobacco dependence in patients with endocrine diseases, especially diabetes mellitus (DM). The main focus of the prevention of diabetes and thyroid diseases is quitting smoking — it benefits even after diagnosis, regardless of smoking experience. The resolution of the expert council contains data from a large Internet survey of regular users of electronic nicotine-containing products with diabetes. 41.9% of respondents reported an improvement in well-being after the complete transition from conventional cigarettes to electronic nicotine-containing products, while only 0.6% of respondents reported a deterioration.
As can be seen from all of the above, the positions of scientists and representatives of various medical specialties — both Russian and foreign — largely converge. The scientific evidence base continues to accumulate, including the long—awaited results of longitudinal studies, which today, due to the relatively recent appearance of electronic smokeless products on the global and Russian market, are still not enough for a comprehensive assessment of its effect on the body in comparison with conventional cigarettes.
However, experts are absolutely united in one thing: no tobacco and nicotine-containing products should be available to minors. And in order to better understand the effectiveness of an alternative approach to the problem of high prevalence of tobacco smoking and work with avid, non-motivated smokers, it is necessary to continue to conduct scientific work and research.
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