Nicotine is toxic to the heart and blood vessels, regardless of whether it is consumed via a vape, a pouch, a shisha or a cigarette, according to an expert consensus report published in the European Heart Journal.

The researchers analyzed all available literature on the topic, and concluded that no nicotine product can be considered safe for the cardiovascular system. Nicotine raises blood pressure, damages vessel walls, and increases the risk of heart attack and stroke even without exposure to tobacco combustion products.

The experts are particularly concerned about the rapid growth in the use of vapes, heated tobacco, and nicotine pouches among adolescents and young people. According to the report, about 75 percent of young people who use electronic cigarettes are former smokers. Experts believe that flavorings, advertising on social media, and weak regulation make these products a starting point to nicotine addiction.

The researchers emphasized that electronic cigarettes and pouches are not an effective means of quitting smoking. On the contrary, their use often leads to dual consumption together with conventional cigarettes. In addition, passive exposure to aerosols from vapes and heated tobacco also harms blood vessels.

The experts called for immediate measures, including a ban on flavorings, a unified packaging requirement, proportional taxation of nicotine content, a complete ban on advertising online and on social media, as well as the expansion of smoke- and aerosol-free zones.

“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,” said Professor Thomas Munzel from University Medical Centre, Mainz, Germany.

According to him, the narrative of “safer nicotine” must end, as adolescents are now the primary targets of aggressive marketing.

“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,” Munzel emphasized.