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The systemic inflammation, increased lipid peroxidation, free radical injury, and endothelial dysfunction contribute to tissue hypoxia, iron accumulation, and liver cell injury that progresses to liver fibrosis over time

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This study addresses this gap by quantifying cadmium, lead, arsenic, chromium, and nickel levels in cigarettes and evaluating their cumulative toxicological impact, providing essential evidence to guide public health policies

Ethics declarations Ethics approval and consent to participate The study is conducted in line with the Helsinki declaration of 1975 (as revised in 2008 and 2013) and has been approved by the Regional Committee for Medical Research Ethics and the safety representative of Oslo University Hospital

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