A new review has raised concerns about the effect of nicotine containing products on the heart and blood vessels. Cigarettes, vapes, heated tobacco products and oral nicotine products such as nicotine pouches all may affect cardiovascular health.
The review published in Nature Reviews Cardiology included laboratory and clinical studies and other scientific research. There was no nicotine as a substance that is currently safe for the cardiovascular system, the researchers said.
That does not mean all nicotine products are at the same risk. Traditional cigarettes are the most harmful because burning tobacco creates many toxic chemicals in addition to nicotine.
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However, the researchers said that moving away from combustion could reduce some harmful exposure without removing the effects of nicotine on the cardiovascular system.
Such findings are of great interest as more people are using electronic cigarettes and nicotine pouches as alternatives to regular smoking.
How does nicotine affect the heart?
Nicotine has a direct effect on the cardiovascular system. It can boost heart rate and blood pressure and narrow blood vessels. So the heart is working harder.
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Nicotine can also activate the body’s sympathetic nervous system and lead to oxidative stress and inflammation, according to the new review. These processes can impact blood vessels’ normal functioning.
Healthy blood vessels should expand and contract properly in order to maintain normal blood flow. Damage to the inner lining of blood vessels (endothelial dysfunction) can be a sign of cardiovascular problems early on.
There have been findings of impaired blood vessel function in people exposed to nicotine delivery systems.
A separate systematic review and meta-analysis published in 2026 also noted that exposure to several tobacco and nicotine products can affect cardiovascular measures. Heart rate, blood pressure and triglyceride levels were all significantly impacted, although research on newer products is less clear and diverse than existing cigarettes.
Cigarettes remain at the top of the risk scale because they combine nicotine with the toxic chemicals created when tobacco burns.
Cigarette smoking is strongly linked to heart attacks, strokes, heart failure and premature death. Tobacco use is also one of the major risk factors for cardiovascular disease and several types of cancer, according to the World Health Organization.
Are Vapes and Nicotine Pouches Safer?
Vapes and nicotine pouches are different from cigarettes, but that does not make them risk free.
Electronic cigarettes do not burn tobacco. They heat a liquid and produce an aerosol that users inhale. The aerosol can contain nicotine and other chemicals, flavouring agents and additives.
The American Heart Association said in June 2026 that growing scientific evidence points to cardiovascular risks from chemicals in e-cigarettes. It also said vaping can cause oxidative stress, inflammation and impaired blood vessel function.
Nicotine pouches are also gaining popularity because they do not produce smoke or vapour. Users put them between the gum and lip to get nicotine into the bloodstream.
But the absence of smoke does not mean there is no cardiovascular risk.
The latest Nature Reviews Cardiology paper found evidence of harmful vascular responses across nicotine delivery systems. At the same time, the study authors added that long-term health data for newer products like nicotine pouches and e-cigarettes are still limited.
It is a good distinction.
For an adult who already smokes cigarettes, switching completely to a less toxic nicotine product may reduce exposure to some toxic substances compared to continuing to smoke. The US Food and Drug Administration, for example, has approved certain ZYN nicotine pouch products with a modified risk claim when used instead of cigarettes.
That does not mean that those products are safe or risk free.
The evidence would suggest that the safest thing to do for heart health is to avoid nicotine products completely.
Young people are also at risk of becoming dependent on nicotine, the study finds. Newer products are more available in different flavours and can be easily used discreetly.
Nicotine is extremely addictive and can impact the developing brain of children, teenagers and young adults.
If people already use nicotine, quitting is hard, as dependence can be fast. Medical support, counselling and established treatments may help people quit using tobacco and nicotine.
The latest research thus challenges the idea that replacing cigarettes with another nicotine product makes the cardiovascular risk disappear.
Different products may expose users to different levels and types of harmful substances, and cigarettes remain the most damaging form of nicotine use. But researchers say there is no nicotine delivery system that can currently be described as completely safe for the heart.
The study also demonstrates why long-term research is needed for new products, particularly in the longer term that haven’t been available for as long as traditional cigarettes.
The key message is simple for consumers. Less harmful than cigarettes does not mean harmless.
Anyone concerned about their nicotine use or heart health should speak with a healthcare professional about quitting and choosing an appropriate cessation approach.
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