A major new expert consensus report published in the European Heart Journal argues that the debate over whether vaping or nicotine pouches are healthier than smoking misses a crucial point: nicotine itself is inherently toxic to the cardiovascular system. Regardless of the delivery method—be it traditional cigarettes, e-cigarettes, heated tobacco products, or oral pouches—nicotine poses a direct threat to heart and blood vessel health.
Lead researcher Dr. Thomas Münzel, a senior professor of cardiology at University Medical Center at Johannes Gutenberg University in Mainz, Germany, stated unequivocally, "Nicotine is not a harmless stimulant; it is a direct cardiovascular toxin." He emphasized that across all nicotine products, researchers consistently observe increased blood pressure, vascular damage, and a heightened risk of heart disease. "No product that delivers nicotine is safe for the heart," Münzel declared.
The report focused specifically on medical evidence regarding nicotine's impact on the cardiovascular system. It found that nicotine drives damage even in the absence of the toxic combustion products, tar, and free radicals found in cigarette smoke. Key toxic effects identified include:
- Triggering acute spikes in heart rate and blood pressure.
- Impairing the ability of blood vessels to expand and contract properly (endothelial dysfunction).
- Promoting the formation of blood clots, thereby increasing the risk of heart attacks and strokes.
- Causing scarring (fibrosis) to the heart tissue.
- Promoting angiogenesis (growth of new blood vessels), which can feed tumor growth.
The researchers stressed that the highly addictive nature of nicotine ensures these toxic effects are endured repeatedly over the long term. "The narrative of 'safer nicotine' must end," Münzel urged. "The next heart attack, the next stroke, the next cardiovascular death may not come from a cigarette, but from a flavored pod, a nicotine pouch or a waterpipe in a café."
Senior researcher Thomas Lüscher, a consultant cardiologist with the Royal Brompton & Harefield Hospitals in London, described the report as "a wake-up call for regulators." He argued that the shift from cigarettes to alternative products represents a "transformation of addiction strategies" rather than effective harm reduction. Consequently, the report calls for comprehensive regulatory actions to reduce nicotine exposure.
"We need political action," Lüscher asserted. "Flavor bans, effective taxation, comprehensive advertising restrictions and the inclusion of vaping and heated tobacco in all smoke-free laws are no longer optional - these are essential measures to prevent cardiovascular disease." He concluded that with the science on nicotine's cardiovascular toxicity now clear, legislators have a duty to protect the public, especially children, from a new epidemic of addiction and disease.
More information
The U.S. Food and Drug Administration has more on the addictive nature of nicotine.
