December 18, 2025

expert reaction to report on nicotine and heart / blood vessels

A report published in the European Heart Journal looks at nicotine and the cardiovascular system. 

Prof Peter Hajek, Professor of Clinical Psychology and Director of the Health and Lifestyle Research Unit, Queen Mary University of London (QMUL), said:

“There is much factually wrong with this report.  In my view this is not a scientific review, but an effort to persuade European regulators to clamp down on any nicotine products like vapes and pouches that do not have pharmaceutical licensing.  The main glaring problem is that the authors fail to acknowledge the extensive and clear evidence that vapes and pouches are far less harmful than smoking. 

“The article and the press release give the impression that vaping or pouches pose the same risks to the heart and blood vessels as smoking. This is not true.  Without everything else you get from burning tobacco, nicotine poses only a small fraction of the risks of smoking to the heart and blood vessels.  Switching from smoking to ‘snus’, Swedish oral tobacco that delivers more nicotine than cigarettes, practically eliminates smoking-related risks of heart attacks and atherosclerosis.   

“The section titled ‘Nicotine as a cardiovascular toxin regardless of delivery method’ even gives as its main source a high quality scientific review of cardiovascular effects of nicotine that came to the opposite conclusion: that ‘risks of nicotine without tobacco combustion products are low compared cigarette smoking’ and that ‘electronic cigarettes appear to pose low-cardiovascular risk’. 

“The article and the press release make other claims that contradict evidence, e.g. that vaping is a gateway into cigarette smoking (when in fact vaping is replacing smoking), that vapes do not help smokers quit (they do), that there is a growing vaping epidemic among youth in the US (vaping in youth declined substantially since 2019).  

“Switching from smoking to vaping or pouch use can help smokers to avoid not only heart disease, but also lung disease and cancer. My concern is that if smokers get the false impression that smoking/vaping/pouches all pose the same risks, it will further discourage them from making the switch.”

‘Nicotine and the cardiovascular system: unmasking a global public health threat’ by first author et al. was published in the European Heart Journal at 00.05 UK time on Thursday 18 December 2025. 

DOI: https://doi.org/10.1093/eurheartj/ehaf1010

Declared interests

Peter Hajek: “No COI”