Nicotine damages the heart and blood vessels regardless of the product
The study focuses on the global burden of disease caused by nicotine consumption. Every year, around 7.7 million people die as a result of active smoking and a further 1.3 million from passive smoking. The majority of these deaths are due to heart attacks, strokes and other cardiovascular diseases. The analysis clearly shows that not only combustion products but also nicotine itself causes cardiovascular damage.
The researchers evaluated more than 100 experimental and clinical studies. The focus was on vascular function as an early marker of cardiovascular damage. Across all product groups, the following was consistently evident: nicotine impairs vascular function, increases blood pressure and exacerbates oxidative stress. These mechanisms promote the development of cardiovascular disease regardless of whether nicotine is smoked, heated, evaporated or absorbed through the oral mucosa. Studies by Mainz University Medical Centre had already shown that even brief exposure to e-cigarettes can trigger measurable vascular changes.
Increasing consumption among young people and risks from passive exposure
The increasing consumption of modern nicotine products among young people is a particular cause for concern. In several European countries, up to 40 percent of 15- to 16-year-olds have already tried e-cigarettes, often without any previous contact with tobacco. Nicotine pouches are also becoming increasingly popular. Modern nicotine salts enable rapid absorption into the brain and promote the rapid development of addiction.
Passive exposure also remains a relevant risk. Even brief exposure to smoke, vapor or aerosols can impair vascular function, not only indoors but also in heavily frequented outdoor areas. Children, pregnant women and people with existing cardiovascular diseases are particularly at risk.
The authors advocate continuing to focus prevention efforts consistently on nicotine products. They say that the protection of children and young people, the reduction of passive exposure and the consistent implementation of existing age and sales regulations should be priorities. The available data show that this is where the greatest preventive benefits can be expected.
Original work:
Thomas Münzel, Filippo Crea, Sanjay Rajagopalan, Thomas Lüscher, Nicotine and the cardiovascular system: unmasking a global public health threat, European Heart Journal, 2025;, ehaf1010, https://doi.org/10.1093/eurheartj/ehaf1010
