Nicotine is harmful to the heart and blood vessels no matter how it is consumed, including vapes, cigarettes, nicotine pouches, heated tobacco or a shisha pipe, according to a study published in the European Heart Journal. This study brings for the first time together evidence on all nicotine products rather than focusing on smoking alone.
The report, written by leading cardiologists from Germany, Italy, the United States and the United Kingdom, sounds the alarm about a rapid rise in the use of vapes and nicotine pouches, particularly among young people. Evidence cited in the report suggests that three-quarters of young adult vapers have never smoked before, meaning these products are creating a new generation of nicotine-dependent users rather than helping existing smokers quit.
The authors are calling for urgent action from regulators across Europe, including bans on flavoured nicotine products, restrictions on social media and influencer advertising, plain packaging, and consistent taxation across all nicotine products.
The key message is straightforward: there is no safe form of nicotine when it comes to heart health. The report finds that all nicotine products raise blood pressure, damage blood vessels and increase the risk of heart disease and even passive exposure to vape emissions and heated tobacco cause harm.
“Nicotine is not a harmless stimulant; it is a direct cardiovascular toxin. Across cigarettes, vapes, heated tobacco, and nicotine pouches, we consistently see increased blood pressure, damage to blood vessels and a higher risk of heart disease. No product that delivers nicotine is safe for the heart. Our findings show that nicotine by itself, even without the multitude of toxic combustion products, tar, or free radicals present in cigarette smoke, drives cardiovascular damage,” said Professor Thomas Münzel from University Medical Centre in Mainz. “The narrative of ‘safer nicotine’ must end. Europe urgently needs unified regulation that covers all nicotine products, especially to protect adolescents, who are now the primary targets of aggressive marketing. Otherwise, we risk losing an entire generation to nicotine addiction. The next heart attack, the next stroke, the next cardiovascular death may not come from a cigarette, but from a flavoured pod, a nicotine pouch, or a waterpipe in a café. If Europe fails to act now, we will face the largest nicotine addiction wave since the 1950s.”
“Our knowledge of cardiovascular risk keeps evolving. Obviously, we must abate the well-known traditional risk factors including hypertension, diabetes, obesity and smoking. Traditional risk factors are only responsible for around half of cardiovascular disease. The remaining half is explained by emerging risk factors including pollution, depression and infections. Use of nicotine, in any form, also contributes to this cardiovascular risk. Cardiovascular disease remains the number one killer, so a strong, comprehensive call to action is needed,” said Professor Filippo Crea from the Catholic University of the Sacred Heart in Rome.
The report’s publication comes at a significant moment for European policy, following a revised EU Tobacco Taxation Directive that, for the first time, introduces minimum taxes on e-liquids, heated tobacco and nicotine pouches. The authors say this is a step in the right direction, but much more is needed.
“This paper is a wake-up call for regulators. The shift from cigarettes to e-cigarettes and flavoured pouches is no effective harm reduction; it is rather a transformation of addiction strategies. We need political action. Flavour 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. Science is clear: the cardiovascular toxicity of nicotine is evidence-based by now. The duty now lies with legislators to protect the public, especially children, from a new epidemic of addiction and disease,” added Professor Thomas Lüscher from Royal Brompton and Harefield Hospitals in London, and President of the European Society of Cardiology.
Thomas Münzel, Filippo Crea, Sanjay Rajagopalan, Thomas Lüscher, Nicotine and the cardiovascular system: unmasking a global public health threat, European Heart Journal, Volume 47, Issue 15, 2026, Pages 1764-1781, https://doi.org/10.1093/eurheartj/ehaf1010