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Table 1 Relationship between health impacts from smoking and key biomarkers for toxicants

From: Improving on estimates of the potential relative harm to health from using modern ENDS (vaping) compared to tobacco smoking

Health loss from smoking

Biomarkers

Sources, comment

Chronic obstructive pulmonary disease (COPD)

Volatile organic compounds (VOCs) e.g., acrolein, crotonaldehyde

The WHO [19], considers these agents to be hazardous with acrolein considered to be: “an intense irritant, is toxic to lung cilia and has been proposed as a lung carcinogen”. Similarly, “crotonaldehyde is a potent irritant and a weak hepatocarcinogen and forms DNA adducts in the human lung.”

All cancers

Tobacco-specific -nitrosamines (TSNAs)

Polycyclic aromatic hydrocarbons (PAHs)

The WHO [19], notes that two TSNAs, “NNK and NNN, are probably responsible for cancers of the lung, pancreas, oral cavity and oesophagus in tobacco users”. “Both have been classified as human carcinogens by working groups at [International Agency for Research on Cancer] IARC.” (See Table 3 regarding NNK and NNN and the full terms).

The WHO [19], notes that: “many PAHs are potent carcinogens or toxicants in laboratory animals (57), and many are present in cigarette smoke, including the prototypic PAH benzo [a] pyrene, classified as a human carcinogen” by a working group convened by the IARC.

Cardiovascular disease

Carbon monoxide (CO)

Acrolein

The WHO [19], states that: “CO is a well established cardiovascular toxicant, which competes with oxygen for binding to haemoglobin. In smokers, it is considered to reduce oxygen delivery, cause endothelial dysfunction and promote the progression of atherosclerosis and other cardiovascular diseases”. A US Surgeon General’s Report also states that: “the mechanisms by which CO may contribute to acute cardiovascular events are well characterized” [20].

The WHO [19] reports that: “cardiovascular tissues appear to be particularly sensitive to the toxic effects of acrolein”. A review on this association has also been published [21].