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LSU Health New Orleans Review Suggests HNB Tobacco Products May Threaten Health

October 19, 2020

Heat Not Burn tobacco product

A review of heat-not-burn (HNB) tobacco products from the laboratory of Dr. Jason Gardner, Professor of Physiology at LSU Health New Orleans School of Medicine, reports an association with elevated blood pressure, increased heart rate, cell death, and circulatory dysfunction shown by early studies. Additionally, chemicals found in the vapor produced by HNB devices have previously been shown to impair lung function, put users at risk of heart attack and stroke, cause cancers, increase circulating low-density lipoprotein (“bad cholesterol”) and more. The review is published in the American Journal of Physiology-Heart and Circulatory Physiology, available online here.

Cigarette smoking continues to decline globally, but vaping is becoming more popular, especially among youth and young adults. Recent cases of vaping-associated lung injury may lead consumers to try new methods of nicotine consumption. Heat-not-burn products are newcomers to the U.S. market. They produce nicotine-containing vapor by heating tobacco at low temperatures. This is in contrast to cigarettes that use high temperatures to burn tobacco and produce smoke or e-cigarettes that heat e-liquid, which contains nicotine but not tobacco, to produce vapor.

Due to the novelty of these products, little research has been conducted on HNB devices. The Gardner lab compiled findings from dozens of human, animal, and cell culture studies to determine associated inhalants and potential health effects, with an emphasis on the heart, arteries, and veins. Findings suggest that HNB devices produce fewer pollutants than cigarettes, but it is unclear if these reductions are reflected in health outcomes of users.

“While relatively new to the U.S., heat-not-burn products have become popular in other countries including Japan, Italy, and Korea,” notes lead author Nicholas Fried, an MD/PhD student in Dr. Gardner’s laboratory. “These products are often touted as a replacement for cigarettes, but the evidence does not necessarily support that. Almost all Korean users of heat-not-burn products are also current cigarette smokers; nearly half of Italian users had never even smoked a cigarette. These trends worryingly suggest that heat-not-burn may be a compliment or gateway to cigarette smoking, rather than a ‘healthy’ replacement. More troubling, nearly 2% of high school students in the U.S. are already using HNB tobacco products, and surveys show that 25% of students are susceptible to trying them. There is potential for these devices to become a significant public health issue.”

Dr. Gardner adds, “Heat-not-burn devices are marketed as a safer alternative to cigarettes for existing smokers. However, as we have learned from vaping and e-cigarettes, these products are very likely to be used by minors and never-smokers due to marketing, flavor options, and lack of social stigma that is found with traditional cigarettes.”

The authors conclude, “Use of these products can lead to nicotine addiction and additional clinical, basic science, and epidemiological studies are needed to better understand the health effects of HNB products. This knowledge will assist consumers, physicians, lawmakers, and regulatory bodies in making informed decisions about these products.”

The authors are supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

______________________________________________________________________________________________________________ LSU Health Sciences Center New Orleans (LSU Health New Orleans) educates Louisiana's health care professionals. The state's health sciences university leader, LSU Health New Orleans includes a School of Medicine with branch campuses in Baton Rouge and Lafayette, the state's only School of Dentistry, Louisiana's only public School of Public Health, and Schools of Allied Health Professions, Nursing, and Graduate Studies. LSU Health New Orleans faculty take care of patients in public and private hospitals and clinics throughout the region. In the vanguard of biosciences research, the LSU Health New Orleans research enterprise generates jobs and enormous annual economic impact. LSU Health New Orleans faculty have made lifesaving discoveries and continue to work to prevent, advance treatment or cure disease. To learn more, visit,, or

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