Nicotine is harmful for cardiovascular health no matter whether it is consumed through smoking a cigarette or chewing tobacco, a major review published in Nature Reviews Cardiology today found. While novel nicotine products – such as e-cigarettes or nicotine pouches – eliminate the smoke and combustion, they are still harmful for the heart.
The review does not suggest that all nicotine products carry the same level of risk. Conventional cigarettes and waterpipes remain the most harmful, largely because of the toxic chemicals produced by combustion. But the authors argue that moving away from smoke does not eliminate cardiovascular harm.
Instead, the researchers describe a “cardiovascular continuum of harm”: combustion products sit at the top, followed by heated-tobacco products, e-cigarettes and oral nicotine products such as chewing tobacco and nicotine pouches.
So while getting rid of smoke reduces cardiovascular harm, getting rid of nicotine altogether is the only way to eliminate the nicotine-related cardiovascular risk.
“E-cigarettes and heat-not-burn devices were initially marketed as reduced-risk alternatives to combustible cigarettes, but our data show these products sit on a continuum of cardiovascular risk, not off it,” said Thomas Münzel, lead author of the review and a professor at the University Medical Centre Mainz, Germany. “Removing combustion clearly reduces harm – but it does not remove it.”
