From the Guidelines
Nicotine use is not beneficial for cardiovascular health and should be avoided due to its harmful effects on the cardiovascular system. Nicotine, whether from cigarettes, e-cigarettes, or other tobacco products, causes immediate and long-term damage to the cardiovascular system, as stated in the 2021 study by the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology 1. When nicotine enters the bloodstream, it triggers the release of adrenaline, increasing heart rate and blood pressure, which puts additional strain on the heart and blood vessels with each use.
Some of the key effects of nicotine on cardiovascular health include:
- Increasing blood pressure and heart rate
- Causing blood vessels to constrict, reducing blood flow throughout the body and forcing the heart to work harder
- Contributing to arterial stiffness and promoting atherosclerosis, the buildup of plaque in arteries that can lead to heart attacks and strokes
- Increasing blood clotting factors, raising the risk of dangerous blood clots
- Damaging the endothelium, the inner lining of blood vessels, impairing their ability to dilate properly
These effects occur regardless of the delivery method, making all nicotine products risky for heart health, as noted in the study 1. For those currently using nicotine, cessation options include nicotine replacement therapies (used temporarily), prescription medications like bupropion or varenicline, and behavioral support programs. It's worth noting that while nicotine replacement shows no adverse effect on outcomes in patients with cardiac disease, as mentioned in the 2016 European guidelines on cardiovascular disease prevention in clinical practice 1, the primary goal should be to avoid nicotine use altogether to minimize cardiovascular risk.
From the FDA Drug Label
Ask a doctor before use if you have • heart disease, recent heart attack, or irregular heartbeat. Nicotine can increase your heart rate. • high blood pressure not controlled with medication. Nicotine can increase your blood pressure
Nicotine use is not beneficial for cardiovascular health because it can increase heart rate and blood pressure, which may be harmful to individuals with heart disease, recent heart attack, or irregular heartbeat 2.
From the Research
Nicotine Use and Cardiovascular Health
- Nicotine use is not beneficial for cardiovascular health due to its potential to contribute to accelerated atherogenesis, induce hyperlipidemia, injure endothelial cells, and promote thrombosis 3.
- Nicotine may also contribute to acute ischemic events in people with existing coronary heart disease by adversely affecting systemic hemodynamics, promoting thrombosis, constricting coronary arteries, and facilitating arrhythmogenesis 3.
- The safety of chronic nicotine exposure, such as with medicinal use of nicotine, cannot be predicted and requires empiric evaluation 3.
Cardiovascular Effects of Nicotine
- Nicotine replacement therapy (NRT) has been associated with an increased risk of cardiac disorders, particularly palpitations, which are a known adverse effect of smoking 4.
- Nicotine may contribute to cardiovascular disease through hemodynamic consequences of sympathetic neural stimulation and systemic catecholamine release 5.
- The doses of nicotine obtained by regular cigarette smoking generally exceed those delivered by NRTs, and the cardiovascular effects of nicotine are more intense when delivered rapidly by cigarette smoking than by transdermal nicotine or nicotine gum 5.
Vascular Dysfunction and Nicotine
- Nicotine alters vasoreactivity through endothelium-dependent and/or endothelium-independent mechanisms, leading to clinical manifestations in both cigarette smokers and e-cig users 6.
- Nicotine induces vascular remodelling through its effects on proliferation, migration, and matrix production of both vascular endothelial and vascular smooth muscle cells 6.
- The role of nicotine in smoking-related cardiovascular disease is complex, and while it may contribute to cardiovascular disease, the evidence among humans is too inadequate to be definitive about such an effect 7.