From the Guidelines
Low dose nicotine does not have proven cardioprotective effects and its use for this purpose is not recommended due to its harmful effects on cardiovascular health. The potential benefits of nicotine on cardiovascular health are highly theoretical and not supported by strong clinical evidence. While some laboratory studies suggest that low doses of nicotine might have beneficial effects on cardiac tissue, such as stimulating angiogenesis and reducing inflammation, these findings are not applicable to real-life clinical practice 1. The European guidelines on cardiovascular disease prevention emphasize that smoking, which contains nicotine, enhances the development of atherosclerosis and thrombotic phenomena, affecting endothelial function, oxidative processes, and inflammation 1. Moreover, nicotine replacement therapy shows no adverse effect on outcomes in patients with cardiac disease, but this does not imply a cardioprotective effect 1. The harmful effects of nicotine, including increased heart rate, blood pressure elevation, and vasoconstriction, outweigh any potential benefits, making it crucial to avoid nicotine entirely for optimal cardiovascular health. Key points to consider include:
- Theoretical benefits of low-dose nicotine on cardiac tissue are not supported by strong clinical evidence
- Nicotine's harmful effects on cardiovascular health, such as increased heart rate and blood pressure elevation, are well-documented
- Avoiding nicotine entirely is the best approach for maintaining optimal cardiovascular health
- Current guidelines do not recommend nicotine for cardioprotection due to insufficient evidence and potential harms 1
From the Research
Theoretical Cardioprotective Effects of Low-Dose Nicotine
- The available evidence does not directly support the notion that low-dose nicotine has theoretical cardioprotective effects 2, 3, 4, 5, 6.
- However, studies suggest that nicotine replacement therapy (NRT) can be used safely in patients with cardiovascular disease, and that the risks associated with NRT are substantially outweighed by the potential benefits of smoking cessation 3, 4, 5, 6.
- Nicotine may contribute to cardiovascular disease through hemodynamic consequences of sympathetic neural stimulation and systemic catecholamine release, but the doses of nicotine obtained by regular cigarette smoking generally exceed those delivered by NRTs 5.
- Clinical trials of NRT in patients with underlying, stable coronary disease suggest that nicotine does not increase cardiovascular risk, and that the effects of cigarette smoking in conjunction with NRT are similar to those of cigarette smoking alone 5.
- The use of NRT in patients with cardiovascular disease is recommended, with guidelines including ensuring dosing does not exceed the manufacturer's recommendation, warning patients to stop using NRT if they relapse to smoking, and targeting motivated smokers with intensive behavioural support 3.