Nicotine Directly Damages Blood Vessels, Raising Heart Attack and Stroke Risk: Study - Video

A new review published in Nature Reviews Cardiology has mapped how nicotine can damage blood vessels, tracing its effects from receptor activation to processes that may contribute to atherosclerosis, plaque rupture, heart attacks and strokes.

The review examined mechanistic, biomarker, preclinical and clinical evidence across major nicotine-containing products. Researchers found that nicotine can directly affect two key types of cells in blood vessel walls: endothelial cells lining the vessels and vascular smooth muscle cells surrounding them.

In endothelial cells, nicotine suppresses prostacyclin, a substance that helps blood vessels relax, while increasing endothelin-1, a powerful vessel-constricting hormone. At the same time, nicotine acts on smooth muscle cells, disrupting potassium channels and calcium regulation. Together, these effects can promote blood-vessel constriction, impaired vascular function and conditions that favour clot formation.

The researchers also outlined a hierarchy of cardiovascular harm across nicotine products. Combustible products, including cigarettes and waterpipes, were associated with the highest cardiovascular risk. They were followed by heated tobacco products, e-cigarettes and oral nicotine products such as pouches and chewing tobacco. Complete abstinence was identified as the only risk-free option.

The authors emphasized that eliminating combustion may reduce cardiovascular harm compared with conventional smoking, but does not eliminate the effects associated with nicotine exposure.

The review also highlights nicotine's strong dependence-forming potential and calls for more consistent regulation across nicotine products rather than separate rules for individual categories.

The researchers recommend stronger measures to prevent nicotine initiation, particularly among young people, alongside taxation, restrictions on flavours and improved evidence-based cessation support.

Importantly, the review does not suggest that every nicotine product carries identical risk. Instead, it indicates that cardiovascular harm exists on a continuum, with combustible products posing the greatest danger and non-combustible products still carrying potential cardiovascular risks.

REFERENCE: Münzel, T., Kuntic, M., Keaney, J.F. et al. Nicotine-containing products and the cardiovascular system: mechanisms and global health implications. Nat Rev Cardiol (2026). https://doi.org/10.1038/s41569-026-01331-6