Nicotine Products: Addictive and Harmful to Cardiovascular Health

Nicotine product use is increasing, a result of the wide availability of smokeless options such as e-cigarettes and oral pouches, and the misconception that nicotine alone is less harmful than tobacco products that contain additional toxic substances. In fact, all nicotine products are addictive and toxic. The rapid uptake of newer nicotine products, particularly among young people, threatens the slow progress over many years in tobacco control and poses substantial risks to cardiovascular health throughout the world.

Background on nicotine

Nicotine is an alkaloid, a nitrogen-containing organic compound typically derived from plants, and the primary addictive component of tobacco.[1] Addiction to nicotine is biologically similar to addiction to heroin and cocaine. Most commercially available nicotine is extracted from tobacco plants, although synthetic nicotine products are also available.

Inhaled nicotine from cigarettes reaches the brain within about 10 seconds after entering the lungs. In the cardiovascular system, nicotine binds to nicotinic acetylcholine receptors. This binding can initiate dysfunctional changes in heart rate, blood pressure and the walls of blood vessels. The activation of the receptors can also increase the risk of blood clots, heart disease, strokes and peripheral artery disease.

Food and Drug Administration (FDA)-approved nicotine products (HABITROL, NICODERM CQ, NICORETTE and generics) for smoking cessation are available over the counter, except for a nasal spray formulation (NICOTROL) that requires a prescription. These products include gums, lozenges and extended-release skin patches. Oral forms provide immediate nicotine doses of 2 or 4 milligrams (mg). Extended-release forms provide doses of 7 to 21 mg over a 24-hour period. As a comparison, the average cigarette delivers a 1- to 2-mg dose of nicotine.[2]

Consumer products that deliver nicotine include cigarettes, heat-not-burn devices, chews, e-cigarettes, vapes, waterpipes, smokeless tobacco (snus) and pouches. For example, the Philip Morris pouch brand Zyn (previously promoted by podcaster Tucker Carlson who, in 2024, launched a competing brand, Alp),[3] comes in 15-packs (palm-held cylindrical containers) of inside-the-lip “pillows” that each typically deliver a 3- or 6-mg dose of nicotine.[4] Flavored Zyn products include “cool mint,” “lemon” and “spiced cider.”

The FDA has limited authority to regulate recreational tobacco products. These products are marketed with little or no regulatory oversight.[5]

Effects of nicotine on the cardiovascular system

A December 2025 report in the European Heart Journal offered a policy blueprint “to protect [cardiovascular health], and prevent the rise of a new generation of nicotine-addicted youth.”[6] Below is a summary of the 12 “key messages” in the report.

1. Nicotine-related cardiovascular disease is a leading global health burden. The first and third leading risk factors for death globally are high blood pressure (10.9 million deaths per year) and smoking (6.2 million deaths per year), respectively. By contrast, six million deaths in total are annually attributed to obesity, alcohol and other drug use.
2. Nicotine is a powerful cardiovascular toxin, regardless of the delivery method. It acts on the sympathetic nervous system, increases blood pressure, and leads to dysfunction of endothelial cells (cells lining the heart and circulatory vessels). Nicotine accelerates atherosclerosis, even in non-combusted forms. Nicotine enhances platelet aggregation, increasing the risk of vasospasm and ischemia in the context of underlying coronary artery disease.
3. No nicotine-containing product is safe for the heart or blood vessels. The FDA, American Heart Association and World Health Organization all agree on this point.[7]
4. E-cigarettes are “far from harmless,” although less harmful than cigarettes because they decrease exposure to some toxins. Still, e-cigarettes cause vascular damage and foster addiction, with uncertain long-term safety.
5. Secondhand exposure to nicotine via exhaust from cigarettes, e-cigarettes and vapes harms blood vessels and increases cardiovascular risk in non-users, especially in children and other vulnerable groups.
6. Nicotine in all forms disrupts the function of endothelial cells through oxidative stress and other biochemical mechanisms.
7. Nicotine use “imposes massive economic burdens on healthcare systems,” estimated at $1.4 trillion annually worldwide.[8]
8. Aggressive marketing by industry, including flavored products, is fueling a youth addiction crisis in Europe and North America. In the United States, high-school-student e-cigarette use increased from 1.5% in 2011 to 27.5% in 2019. The use of nicotine pouches has markedly increased as well.
9. “Decades of accumulating evidence and global expert consensus confirm” that all nicotine products pose serious cardiovascular risk and that the there is no safe level of nicotine use.
10. To safeguard the public, multiple policy measures are needed, including taxation, youth protection and targeted regulatory approaches.
11. “Comprehensive indoor and outdoor bans on smoking, vaping and waterpipes are essential to protect public health,” particularly in urban areas and other settings considered high risk for exposure.
12. “Cardiologists must integrate nicotine prevention into routine care.”

What You Can Do

To protect your cardiovascular health, avoid nicotine-containing products of all types except for approved products for smoking cessation, such as an FDA-approved nicotine spray, patch, gum or lozenge. Although quitting tobacco products can be challenging, medical supervision and counseling may help.[9]

References

[1] Dorotheo EU, Arora M, Banerjee A, et al. Nicotine and cardiovascular health: When poison is addictive - a WHF policy brief. Glob Heart. 2024;19(1):14.

[2] Ibid.

[3] Dorment R. ‘Is ALP addictive? F*ck yeah, it’s addictive!’ Men’s Health. January 13, 2026. https://www.menshealth.com/health/a69730859/tucker-carlson-nicotine-interview/. Accessed March 810, 2026.

[4] Northerner. ZYN nicotine pouches. https://www.northerner.com/us/zyn?utm_source=zyn_referral&utm_medium=faq_referral&utm_campaign=zyn_website_faq&utm_id=zyn&utm_content=zyn_website_faq. Accessed March 10, 2026.

[5] Sheikh HA, Green VR. FDA regulation of tobacco products. July 9, 2021. Congressional Research Service. R45867.

[6] Münzel T, Crea F, Rajagopalan S, Lüscher T. Nicotine and the cardiovascular system: unmasking a global public health threat. Eur Heart J. doi: 10.1093/eurheartj/ehaf1010. Published online ahead of print 2025 December 18, 2025:ehaf1010.

[7] Ibid.

[8] Ibid.

[9] Quitting smoking: Behavioral therapy and medications can help. Worst Pills, Best Pills News. August 2021. https://www.worstpills.org/newsletters/view/1417. Accessed March 10, 2026.