Nicotine Products Harm Heart

A major review published in Nature Reviews Cardiology has found that all nicotine-containing products, including smoking, vaping, and nicotine pouches, are harmful to the heart. The review identified a 'cardiovascular continuum of harm' with combustion products being the most harmful, followed by heated-tobacco products, e-cigarettes, and oral nicotine products.

The review, led by Professor Thomas Münzel of the University Medical Centre Mainz, Germany, found that nicotine is harmful for cardiovascular health regardless of whether it is consumed through smoking, chewing tobacco, or other nicotine-containing products. Conventional cigarettes and waterpipes are the most harmful nicotine-containing products due to the toxic chemicals produced by combustion.

The 'cardiovascular continuum of harm' ranks combustion products as the most harmful, followed by heated-tobacco products, e-cigarettes, and oral nicotine products. Nicotine damages the cardiovascular system through two separate mechanisms: affecting the endothelium and acting directly on vascular smooth muscle cells.

Professor Münzel stated that 'Removing combustion clearly reduces harm – but it does not remove it.' E-cigarettes and heat-not-burn devices were initially marketed as reduced-risk alternatives to combustible cigarettes, but the review found they sit on a continuum of cardiovascular risk.

The review identified oxidative stress, arterial stiffness, and inflammatory responses as contributing to the harm caused by nicotine to the cardiovascular system. The findings suggest that while getting rid of smoke reduces cardiovascular harm, getting rid of nicotine altogether is the only way to eliminate the nicotine-related cardiovascular risk.

## Why it matters The review's findings have significant implications for public health, as they suggest that all nicotine-containing products pose a risk to cardiovascular health. The 'cardiovascular continuum of harm' provides a framework for understanding the relative risks of different nicotine-containing products, and highlights the need for caution when using any of these products. As the world continues to grapple with the health effects of nicotine, this review provides important insights into the harm caused by nicotine-containing products and the need for effective regulation and education.