How Different Nicotine Products Affect Heart and Blood Health

• Nicotine can temporarily increase heart rate and blood pressure.
• The speed of nicotine delivery affects how strongly the cardiovascular system responds.
• Cigarette smoke contains chemicals that increase cardiovascular risk.
• Smoke-free nicotine products avoid combustion and carbon monoxide exposure.
• Long-term cardiovascular research on vaping and nicotine products is still developing.

This article provides general information for adults who use nicotine and is not intended as personalised medical advice.

Nicotine is a stimulant that activates the sympathetic nervous system, which is often called the body’s “fight or flight” response.

When nicotine enters the body, the short-term effects that have been observed in studies include:^1,2

• Increased heart rate
• Narrowing blood vessels
• Raised blood pressure

These cardiovascular changes are usually short-lived and typically fade once nicotine leaves the body.

How noticeable these effects are on the cardiovascular system depends on several factors, including:

• How much nicotine is used
• How quickly nicotine enters the bloodstream
• Individual tolerance
• Other chemicals that are inhaled

When it comes to individuals with existing heart disease using nicotine, here’s what the British Heart Foundation says:³

“Nicotine is a problem for people with heart disease. It raises the heart rate, contradicting the goal of most treatments.”

Different nicotine products affect the cardiovascular system in varying ways.

Generally, products that deliver nicotine more quickly create faster and stronger short-term cardiovascular responses.

Cigarettes deliver nicotine extremely quickly through inhalation.

Nicotine binds to receptors on adrenal glands and stimulates the release of adrenaline, which increases heart rate and blood pressure.

Beyond nicotine, carbon monoxide in cigarette smoke can reduce oxygen delivery.

Over time, smoking damages blood vessels and arteries through inflammation and increases the risk of heart attack, stroke, heart failure, and other vascular diseases.⁴

Most of the damage associated with cigarettes comes from toxic combustion products.

Vapes deliver nicotine by heating a liquid into an aerosol. Vapes do not burn tobacco, which means no combustion and no carbon monoxide.

In the short term, vaping can temporarily raise heart rate and blood pressure and affect blood vessel function.⁵

There is not enough research into the long term effects of vaping on the cardiovascular system, compared with the decades-long data we have with cigarettes.

According to the British Heart Foundation:³ 

“More research is needed on the long-term impact of vaping on your heart and blood vessels.”

Nicotine pouches and tobacco snus are oral nicotine products that avoid smoke and inhalation altogether. This means they do not involve carbon monoxide and combustion.

With these products, nicotine is absorbed slowly through the mouth.

There is little research on nicotine pouches, as these are a relatively new product.

However, there are some studies which have looked at Swedish (tobacco) snus. Nordic and European studies have found a mixed picture when it comes to the cardiovascular effects of snus:^6,7

• Most Swedish snus studies show no increased risk of heart attack, heart failure, or stroke risk.
• Others found a small increase in stroke risk compared to never smokers.

Because nicotine pouches work in a similar way to snus, researchers are continuing to investigate whether they have a comparable effect on the cardiovascular system.

NRTs (Nicotine Replacement Therapies) include nicotine gum, lozenges, patches, inhalers, and mouth sprays. As with nicotine pouches and snus, they deliver nicotine slowly.

NRTs have been studied extensively. Meta-analyses (which review results from multiple studies) and cohort data (where researchers track a group of people over time) have found that NRTs may slightly increase mild cardiovascular symptoms, e.g. fluttering or faster heartbeat or chest discomfort.⁹

However, NRTs have not been shown to increase the risk of serious cardiovascular events like heart attacks or stroke, even in people with heart disease.^8,9

One of the biggest differences between nicotine products is whether combustion occurs.

Combustion happens when tobacco burns. Burning tobacco creates thousands of chemicals, many of which (including carbon monoxide) are known to damage the cardiovascular system.

Smoke-free nicotine products, such as nicotine pouches, snus, vapes, and NRTs, avoid combustion entirely.

However, it’s important to note that smoke-free does not mean risk-free.

Researchers continue to study whether long-term nicotine exposure itself contributes to cardiovascular disease.

Large reviews examining nicotine replacement therapies and smokeless nicotine products have generally not found major increases in:²

• Heart attack
• Stroke
• Cardiovascular mortality

A 2016 review evaluated evidence on nicotine and cardiovascular disease and concluded that NRTs did not significantly increase serious cardiovascular events in people with existing cardiovascular disease, particularly when their condition was stable.

However, scientists are still researching whether long-term nicotine exposure affects blood pressure, inflammation, blood vessels, and arteries.

This is particularly relevant for newer products such as vapes and nicotine pouches, which lack long-term datasets.

• Action on Smoking and Health (ASH): “Nicotine is addictive but carries few direct risks to health on its own…However, it should not be used by people who do not already smoke.”
• British Heart Foundation (BHF): “Nicotine, while highly addictive, is not a significant health hazard for people without heart conditions. It does not cause acute cardiac events or coronary heart disease, and is not carcinogenic. But nicotine is a problem for people with heart disease.”
• National Health Service (NHS): “While nicotine is a highly addictive drug, it does not contain toxic chemicals found in cigarettes, including tar and tobacco.”

Nicotine can temporarily increase heart rate and blood pressure, but its effects on the cardiovascular system depend on how it is delivered to the body.

Smoke-free nicotine products avoid combustion, which produces toxic chemicals that damage the cardiovascular system.

Researchers are still studying the long-term cardiovascular effects of newer nicotine products, such as nicotine pouches and vapes.