Updated publication reference for PubMed record(s): 26582801, 26609137. Cigarette smoking is a major risk factor for the development and progression of cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD), so modified risk tobacco products (MRTPs) are being developed to reduce smoking-related health risks. The present study investigated the hallmarks of COPD and CVD over an 8-month period in apolipoprotein E-deficient mice exposed to conventional cigarette smoke (CS) or to an aerosol from a candidate MRTP, the tobacco heating system (THS2.2). In addition to chronic exposure, cessation or switching to THS2.2 after 2 months of CS was investigated. In a systems toxicology approach, exposure effects were investigated using physiology and histology combined with transcriptomics, lipidomics, and proteomics. CS induced nasal epithelial hyperplasia and metaplasia, lung inflammation, and emphysematous changes (impaired pulmonary function and alveolar damage). Atherogenic effects of CS exposure included altered lipid profiles and increased aortic plaque formation. Exposure to THS2.2 aerosol (nicotine concentration matched to CS: 29.9 mg/m3) did not induce lung inflammation or emphysema, nor did it consistently change the lipid profile or enhance the plaque area. Cessation and switching reversed the inflammatory responses and led to no further progression of initial emphysematous changes or the aortic plaque area. Biological processes, including senescence, inflammation, and proliferation, were significantly impacted in CS, but not THS2.2-exposed tissues. Cessation or switching reduced these perturbations to become nearly indistinguishable from sham exposure. In conclusion, this mouse model indicated that cessation or switching to THS2.2 retarded the progression of atherosclerotic and emphysematous changes, while THS2.2 alone had no adverse effects.