Nicotine itself, not just the smoke that carries it, appears to attack the walls of blood vessels within minutes of exposure.
That is the central conclusion of a comprehensive review published in Nature Reviews Cardiology, which maps how the drug drives the plaque rupture behind heart attacks and strokes.
The paper, led by cardiologist Thomas Münzel of University Medical Center Mainz in Germany, applies whether nicotine reaches the bloodstream through a cigarette, a vape, a heated tobacco stick, a pouch or a patch.
How the damage unfolds
The team identifies two independent pathways. Nicotine suppresses prostacyclin, a natural relaxant that keeps vessels open, and triggers release of endothelin-1, one of the body's most powerful vessel-constricting hormones.
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At the same time, it acts on the smooth muscle cells around the vessel by blocking ATP-sensitive potassium channels and disrupting how those cells handle calcium.
The net effect is endothelial dysfunction, the earliest measurable step toward atherosclerosis, high blood pressure and heart failure.
"Nicotine doesn't only disable the vessel's protective lining, it directly tightens the muscle around it," Münzel said.
An earlier paper from the same author group in the European Heart Journal, published in December 2025, laid out the same core mechanism and added that nicotine also stiffens arteries and makes blood more likely to clot.
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Vaping is not off the risk curve
The review sets out a hierarchy of cardiovascular harm. Combustible cigarettes and waterpipes sit at the top, followed by heated tobacco products, then e-cigarettes, then oral products such as pouches and snus. Only complete abstinence carries no cardiovascular risk.
That matters for a growing group of Americans, especially young adults, who reach for vapes because they believe they are safe.
CDC data on adult e-cigarette use through 2023 show that 15.5 percent of adults aged 21 to 24 currently used e-cigarettes, the highest rate of any age group.
The American Heart Association reached a similar conclusion in June 2026, citing evidence that e-cigarette chemicals damage the heart and vessels. "No tobacco or nicotine product can be considered safe," said Nancy Brown, chief executive of the association.
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Why the mechanism story matters
Public health messaging has long focused on tar, carbon monoxide and the thousands of chemicals released by burning tobacco. The review does not disagree that combustion is worse.
Removing the smoke reduces harm, the authors note, but it does not erase the vessel damage caused by nicotine itself.
That distinction changes how a nicotine patch, a pouch or a vape should be understood. As a short-term tool to quit cigarettes, replacement products have a documented role.
As long-term substitutes, they still hit the same vessel receptors that drive the disease process the review describes.
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An earlier Welltica report on vaping and blood vessels covered a smaller study reaching similar conclusions.
Anyone considering nicotine of any form for the long run, or trying to stop, should talk with their doctor about the safest way off it.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.