Smoke-free products can save the lives of millions of hardened smokers, says expert

MANILA, Philippines — Smoke-free products such as vapes and heated tobacco products that deliver nicotine without burning tobacco can save the lives of millions of hardened smokers who are unable to quit smoking, according to a distinguished Israeli cardiologist.

“Quitting smoking is very difficult because tobacco contains nicotine, which is highly addictive. But it’s not nicotine that causes the serious health effects of tobacco use. It’s the thousands of chemicals produced by the burning of tobacco that make smoking so deadly,” said Prof. Reuven Zimlichman, Director of The Brunner Cardiovascular Research Institute at Tel-Aviv University in Israel.

Zimlichman traveled recently to the country to serve as a resource speaker at the 46th Philippine Neurological Association (PNA) Annual Convention held from November 26 to 29, 2024, at the Conrad Manila in Pasay City.

According to Zimlichman, almost half (49%) of smokers diagnosed with coronary artery disease (narrowing or blockage of the arteries that supply blood to the heart) continue to smoke, 57% of smokers continue to smoke after a stroke, and 72% of smokers diagnosed with peripheral artery disease (narrowing of the arteries that supply blood to the arms and legs) continue to smoke.

“Nicotine is addictive, but it doesn't harm the body. It's not carcinogenic, and it doesn't cause heart disease or blood vessel disease. If there is an alternative way to satisfy the nicotine craving of smokers without burning tobacco, this is clearly an option worth considering,” Zimlichman said.   

Zimlichman believes that heated tobacco products and vapes, which are forms of tobacco harm reduction, are technological innovations that have the potential to save millions of lives. Tobacco harm reduction is a public health strategy that aims to provide less harmful alternatives to people who do not want to quit smoking by themselves or with currently approved methods.

Heated tobacco products are lithium battery-powered devices that heat the tobacco just enough to release a nicotine-containing tobacco aerosol but without burning the tobacco.

Because tobacco is heated and not burned, there is no smoke, and the levels of harmful and potentially harmful chemicals in the generated aerosols can be significantly reduced compared to cigarette smoke.

“Heated tobacco products offer the best chance for hardened smokers to quit smoking,” Zimlichman said.

Vapes or e-cigarettes are lithium battery-powered devices that heat a liquid (called an e-liquid) that typically contains nicotine, propylene glycol, vegetable glycerin and flavorings.

The e-cigarette converts the e-liquid into a mist or vapor that the user inhales. This is why using an e-cigarette is known as vaping.

E-cigarettes do not burn tobacco and do not produce tar or carbon monoxide, two of the most damaging elements in tobacco smoke.

He cited the results of a 2021 South Korea study, which showed that switching to smoke-free products was associated with 23% less risk of cardiovascular disease among both recent and long-term switchers. The reduction in cardiovascular disease risk among switchers was mostly attributed to heated tobacco products.

Previously a non-believer in tobacco harm reduction, Zimlichman changed his position after reviewing the emerging scientific evidence supporting the novel public health strategy.

“After over 50 years of implementing essentially the same tobacco control strategies, nothing has changed. There are currently an estimated one billion smokers globally, with 8 million people dying of smoking-related diseases every year. We need to try something new. Governments, regulatory agencies, and the medical community need to be open to new ideas such as tobacco harm reduction,” he explained.

Zimlichman acknowledged the progress of Sweden, Japan and the UK in reducing smoking rates and tobacco-related sickness and deaths after integrating tobacco harm reduction into their public health programs.

Sweden has gained international recognition for its widespread adoption of snus and nicotine pouches, along with public education efforts, which have significantly reduced smoking rates in the country.

According to Smoke-Free Sweden, a campaign that encourages countries to follow the Swedish model of tobacco harm reduction, the cancer incidence in Sweden is 41% lower than the European average and it has the lowest percentage of tobacco-related diseases among EU countries. 

Asked for his message to Filipino doctors who manage patients with cardiovascular disease who are hardened smokers, Zimlichman said, “Ask your patient to consider switching to a heated tobacco product or vape. The more severe the patient’s cardiovascular disease is, the more benefits they can derive from switching.”