Nicotine products pose cardiovascular risks regardless of delivery method

A comprehensive review published in Nature Reviews Cardiology indicates that no nicotine-containing product is entirely safe for cardiovascular health. While eliminating combustion from products like cigarettes reduces certain risks, the nicotine itself remains harmful to the heart and blood vessels.

Lead author Professor Thomas Münzel of the University Medical Center Mainz explains that nicotine creates a ‘continuum of cardiovascular damage.’ Traditional cigarettes and hookahs sit at the highest risk level due to toxic combustion byproducts, followed by heated tobacco, e-cigarettes, and oral nicotine products like pouches or chewing tobacco.

The research details a biological pathway where nicotine binds to receptors in blood vessel walls, triggering a cycle of inflammation and clot formation. Specifically, nicotine suppresses prostacyclin, a natural vasodilator, and triggers the release of endothelin-1, a potent hormone that constricts vessels. It also disrupts calcium handling in vascular smooth muscle cells, further promoting constriction. The study concludes that while moving away from smoke reduces damage, complete cessation of nicotine is the only way to eliminate these specific cardiovascular risks.