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First, as this was a TLR and not a systematic literature review, there may have been some bias present during article selection and extraction, with relevant studies potentially missed

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federal law defines roll-your-own tobacco as tobacco that, because of its appearance, type, packaging, or labeling, is suitable for use and likely to be offered to, or purchased by, consumers as tobacco for making cigarettes

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Policy takeaway: Despite marketing claims of safer alternatives, no nicotine-containing product, whether smoked, heated, inhaled, or absorbed, can be considered safe for the heart and blood vessels, a consensus formally supported by the ESC, AHA, FDA, and WHO