A NEW trend in tobacco-linked cardiovascular risk has emerged from Japan, showing fewer hospitalisations for acute coronary syndrome (ACS) among younger adults as heated tobacco products (HTPs) gain popularity. Researchers found these declines mainly in areas with higher HTP use.
Growing Popularity of Heated Tobacco Products
The rise of HTPs has reshaped traditional smoking patterns and renewed debate over tobacco-associated cardiovascular risk, particularly among younger smokers. In Japan, more than half of adults aged 20–49 now use HTPs, reflecting a national shift towards reduced-exposure tobacco alternatives. Although earlier analyses showed limited association between HTPs and ACS admissions soon after their introduction, the rapid expansion of use since 2017 prompted researchers to reassess the potential implications for cardiovascular health.
Study Design and Key Results
Researchers used data from the Japanese Registry of All Cardiac and Vascular Disease–Diagnosis Procedure Combination (2013–2022) and performed an interrupted time-series analysis. Among 370,178 hospitalised patients (mean age 70.5 years; 72.1% men), total ACS admissions showed no overall difference before and after HTP introduction (slope change, −4.01; 95% CI, −12.54 to 4.52). However, younger adults (20–49 years) and smokers demonstrated significant downward trends (slope changes, −1.33 and −5.14, respectively), as did regions such as Tokyo with greater HTP prevalence. These findings indicate that shifts in cardiovascular risk patterns may correspond to changing product use behaviours.
Future Perspectives for Tobacco Cardiovascular risk
This observed decline in ACS hospitalisations among younger and smoking populations suggests a potential link between HTP spread and reduced acute cardiac events. Nonetheless, confounding factors, such as long-term reductions in smoking rates, tobacco tax increases, and pandemic-related influences, must be considered. Further longitudinal studies are required to determine causality. From a clinical standpoint, continued monitoring of emerging tobacco products and their relationship to tobacco cardiovascular risk remains essential to guide public health strategies and cardiovascular prevention policies.
Reference
Iwanaga Y et al. Heated tobacco product spread and hospitalizations for acute coronary syndrome in Japan. JAMA Netw Open. 2025;8(10):e2537334.
