Nicotine in any Form Is Harmful to the Heart

Regardless of whether nicotine is burned, heated, inhaled,

or simply kept in the mouth as a pouch, the European Soci-

ety of Cardiology classifies nicotine as a direct cardiovascu-

lar toxin in a consensus paper. This assessment was based

on an evaluation of all available literature on nicotine con-

sumption. It showed that no product containing nicotine is

harmless to the cardiovascular system. This is because nic-

otine and associated toxins trigger oxidative stress and in-

flammation, leading to endothelial dysfunction, an impor-

tant early sign of vascular damage. Persistent endothelial

damage promotes the development of cardiovascular dis-

ease, which ultimately manifests in the form of high blood

pressure, acute and chronic coronary syndromes, heart

failure, stroke, and arrhythmia. The authors conclude that

e-cigarettes, water pipes, nicotine pouches, and heated to-

bacco are not suitable for smoking cessation.

In view of a new wave of nicotine addiction, which is pri-

marily affecting teenagers and young adults with flavored

nicotine products, the consensus authors are calling for a

coordinated European strategy that universally regulates all

nicotine products. Otherwise, there is a risk of losing an en-

tire generation to nicotine addiction. 

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Source: Münzel T et al.: Nicotine and the cardiovascular system: unmasking a global public health threat. Eur Heart J. Published online 18 December 2025. doi:10.1093/eurheartj/ehaf1010

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