Yüce Yunus, Can Eke Benay
Department of Consumer Safety and Public Health Laboratories, Toxicology Laboratory, Minister of Health, General Directorate of Public Health, Ankara, Türkiye.
Graduate School of Health Sciences, Ankara University, Ankara, Türkiye.
Toxicol Mech Methods. 2025 May 26:1-16. doi: 10.1080/15376516.2025.2506796.
There has been a sharp increase in the use of e-cigarettes and heated tobacco products (HTPs) in the last decade. Related to the increase in the use, serious public health debates have been caused by the safety and risks of these products. Particularly due to the exposure to a lot of toxic substances, including heavy metals, there has been an increasing concern over their health effects. Heavy metals such as lead, arsenic, mercury, and cadmium are environmental pollutants poising significant health risks. These metals have a disposition to accumulate in the human body over time. Even at lower levels of exposure, they might lead to multiple organ damage and adverse health effects, including neurotoxicity, nephrotoxicity, and being carcinogenicity.
This study tests the idea that using electronic cigarettes (e-cigarettes) and IQOS devices raises the levels of metals in urine and that the amount of increase depends on which product is used. The study aims to look at the levels of lead, cadmium, nickel, zinc, and selenium in the urine of cigarette smokers, e-cigarette users, IQOS users, and nonsmokers; to check for significant differences in metal levels between these groups (with a significance level set at < 0.05); to compare the metal levels found with safety limits; and to explore if there's a link between the metal levels in urine and the type of product used (cigarettes, IQOS, or e-cigarettes).
This study aimed to compare the trace element, heavy element, and nicotine exposures of individuals who smoke ( = 39), use e-cigarettes ( = 28), use IQOS ( = 20), and do not use tobacco or tobacco products ( = 30) while living in Ankara, Türkiye. In order to evaluate the element levels of the participants, the levels of lead, cadmium, nickel, zinc, and selenium metals in their urine were determined using inductively coupled plasma mass spectrometry (ICP-MS), and nicotine exposures were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS).
The measurement showed that lead levels were higher in IQOS users (8.51 ng/g creatinine) and smokers (3.67 ng/g creatinine) compared to e-cigarette users (1.38 ng/g creatinine), and this difference was statistically significant ( < 0.05). In addition, a statistically significant difference was found between the cotinine level and lead level of the smoking and IQOS groups ( ˂ 0.05). No statistically significant difference was found between the groups in terms of cadmium level ( > 0.008). Nickel level was found to be higher in e-cigarette (3.43 ng/g creatinine) and IQOS (3.84 ng/g creatinine) users than in the smoking group (0.99 ng/g creatinine). In terms of nickel, a statistically significant difference was found between the e-cigarette and IQOS groups and both the smoking and control groups ( ˂ 0.05). No statistically significant difference was found between the selenium level and both the groups and the cotinine level ( > 0.008). Zinc levels were higher in IQOS users (596.13 ng/g creatinine) than in e-cigarette users (298.40 ng/g creatinine) and cigarette users (217.59 ng/g creatinine). No statistically significant difference was found between the cotinine levels of e-cigarette, IQOS, and cigarette users ( > 0.05).
This study investigated metal exposure profiles by comparing urinary metal concentrations across different groups of tobacco product users (cigarette smokers, IQOS users, and e-cigarette users). The findings revealed that lead and cadmium levels were significantly higher in cigarette smokers compared to nonsmokers. In contrast, elevated nickel concentrations were notably observed among IQOS and e-cigarette users. Variations in zinc and selenium levels appeared to be more attributable to physiological or external factors rather than product use. Overall, the results suggest that both conventional and novel tobacco products may pose potential toxicological risks related to metal exposure among users. However, the observed metal concentrations generally fell below established regulatory thresholds.
在过去十年中，电子烟和加热烟草制品（HTPs）的使用急剧增加。与使用量的增加相关，这些产品的安全性和风险引发了激烈的公共卫生辩论。特别是由于接触大量有毒物质，包括重金属，人们对其健康影响的担忧日益增加。铅、砷、汞和镉等重金属是对健康构成重大风险的环境污染物。随着时间的推移，这些金属倾向于在人体中积累。即使在较低的接触水平下，它们也可能导致多器官损伤和不良健康影响，包括神经毒性、肾毒性和致癌性。
本研究检验了使用电子烟和IQOS设备会提高尿液中金属水平，且增加量取决于所使用产品这一观点。该研究旨在观察吸烟者、电子烟使用者、IQOS使用者和非吸烟者尿液中铅、镉、镍、锌和硒的水平；检查这些组之间金属水平的显著差异（显著性水平设定为<0.05）；将发现的金属水平与安全限值进行比较；并探讨尿液中的金属水平与所使用产品类型（香烟、IQOS或电子烟）之间是否存在关联。
本研究旨在比较居住在土耳其安卡拉的吸烟者（n = 39）、使用电子烟者（n = 28）、使用IQOS者（n = 20）以及不使用烟草或烟草制品者（n = 30）的微量元素、重金属元素和尼古丁暴露情况。为了评估参与者的元素水平，使用电感耦合等离子体质谱法（ICP-MS）测定其尿液中铅、镉、镍、锌和硒金属的水平，并使用液相色谱-串联质谱法（LC-MS/MS）测定尼古丁暴露情况。
测量结果显示，与电子烟使用者（1.38 ng/g肌酐）相比，IQOS使用者（8.51 ng/g肌酐）和吸烟者（3.67 ng/g肌酐）的铅水平更高，且这种差异具有统计学意义（<0.05）。此外，吸烟组和IQOS组的可替宁水平与铅水平之间存在统计学显著差异（<0.05）。各组之间的镉水平未发现统计学显著差异（>0.008）。发现电子烟使用者（3.43 ng/g肌酐）和IQOS使用者（3.84 ng/g肌酐）的镍水平高于吸烟组（0.99 ng/g肌酐）。就镍而言，电子烟组和IQOS组与吸烟组和对照组之间均存在统计学显著差异（<0.05）。硒水平与各组以及可替宁水平之间未发现统计学显著差异（>0.008）。IQOS使用者（596.13 ng/g肌酐）的锌水平高于电子烟使用者（298.40 ng/g肌酐）和香烟使用者（217.59 ng/g肌酐）。电子烟使用者、IQOS使用者和香烟使用者的可替宁水平之间未发现统计学显著差异（>0.05）。
本研究通过比较不同烟草制品使用者组（吸烟者、IQOS使用者和电子烟使用者）的尿液金属浓度来调查金属暴露情况。研究结果显示，与非吸烟者相比，吸烟者的铅和镉水平显著更高。相比之下，在IQOS使用者和电子烟使用者中明显观察到镍浓度升高。锌和硒水平的变化似乎更多归因于生理或外部因素而非产品使用。总体而言，结果表明传统和新型烟草制品都可能给使用者带来与金属暴露相关的潜在毒理学风险。然而，观察到的金属浓度通常低于既定的监管阈值。
