Designed to Addict: Newer Tobacco and Nicotine Products Are a Threat to Cardiovascular Health

The World Heart Federation (WHF) is proud to celebrate World No Tobacco Day - under the banner Unmasking the Appeal: Countering Tobacco and Nicotine Addiction - together with the global cardiovascular health and tobacco control communities.

Tobacco use and exposure to second-hand emissions are responsible for over 7 million deaths each year. Tobacco remains a major - yet entirely preventable - risk factor for cardiovascular morbidity and mortality, accounting for approximately 15% of all cardiovascular-related deaths in 2023.

The Cost of Nicotine

Nicotine is widely recognized as the principal addictive substance that lies at the centre of the tobacco pandemic. By sustaining addiction, it repeatedly exposes users, as well as bystanders, to a wide range of toxic chemicals found in both traditional and newer products. In addition, evidence shows that nicotine is far from innocuous, even on its own. Nicotine can directly harm the cardiovascular system through various mechanisms, negatively affecting heart rate, blood pressure, endothelial function, and other key pathways.

The rise in popularity of newer tobacco and recreational nicotine products - such as electronic delivery systems (e.g., electronic cigarettes, etc.), heated tobacco products (HTPs), and nicotine pouches - raises grave concerns. In recent years, newer products have been heavily promoted through flashy designs, attractive aesthetics, enticing flavours, and misleading health claims.

Their growing use among young people has been especially alarming. The World Health Organization (WHO) reports that at least 40 million children aged 13-15 currently use at least one tobacco or nicotine product globally, with at least 15 million adolescents, in that age range, using e-cigarettes. These figures point to a new wave of nicotine addiction, fuelled by products that are deliberately designed to be appealing and accessible to youth.

Engineering Lifelong Addiction

Modern e-cigarettes and heated tobacco products can deliver nicotine in concentrations comparable to, or even higher than, conventional cigarettes. Newer products are precisely engineered to deliver nicotine in doses and profiles that both initiate and sustain addiction, especially among adolescents and young adults, who represent a highly vulnerable population.

The tobacco industry has a long history of systematic and deliberate interference in public health and science. Through misleading claims, biased industry-funded research, and its so-called "harm reduction" narrative, it has sought to sow unnecessary and harmful confusion and controversy among the public, scientists, and policymakers. In particular, the industry leverages newer tobacco and nicotine products to exploit regulatory gaps, as part of a broader effort to re-normalize use, attract new users, and perpetuate addiction.

Tobacco and Nicotine Cessation

In November 2025, WHF highlighted that tobacco cessation remains one of the most effective interventions to reduce the global burden of tobacco, at the Eleventh session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control. WHF also reiterated that electronic cigarettes and heated tobacco products are associated with increased risks of cardiovascular disease and other health harms, with limited effectiveness for cessation in real-world settings.

Newer tobacco and recreational nicotine products should not be promoted as cessation tools unless formally assessed and approved by relevant national regulatory authorities for that specific purpose. In contrast, medications listed on the WHO Model List of Essential Medicines - such as varenicline, bupropion, cytisine, and authorized nicotine replacement therapies - remain the most effective pharmacological treatments for cessation, supported by well-documented safety data and established protocols to achieve total abstinence.

WHF believes that tobacco and nicotine cessation must be recognized as an essential service, particularly in cardiovascular settings. Healthcare professionals, especially cardiologists, play a key role in identifying tobacco use, advising patients, and providing evidence-based support or referral. In fact, failing to provide cessation services to people living with cardiovascular disease could be considered a critical oversight.

In response, WHF collaborated with the Nicotine Addiction and Tobacco Use Treatment Initiative (NATTI) to strengthen cessation capacity among healthcare professionals, including through an accredited webinar for cardiologists.

WHF's Call to Action

Nicotine addiction is no coincidence. It results from products designed to trap users and from industry strategies designed to obscure harm, evade regulation, and protect profits over human lives.

On World No Tobacco Day, in line with its Policy Brief on Nicotine and Cardiovascular Health, WHF calls for decisive action to protect everyone, everywhere from the health, social, economic, and environmental consequences of tobacco and nicotine addiction. In particular, we call on governments and all relevant stakeholders to:

• Fully implement the WHO Framework Convention on Tobacco Control, especially Articles 5.3 and 14;
• Prohibit the addition of flavouring agents in all tobacco and recreational nicotine products to reduce appeal to youth;
• Prohibit the use of all emission-generating tobacco and nicotine products in indoor public places, workplaces, and public transport;
• Prohibit and monitor the dissemination of misleading claims regarding the health effects of tobacco and recreational nicotine products; and
• Strengthen research on the long-term effects of newer tobacco and nicotine products on cardiovascular health.

Finally, WHF strongly urges people living with cardiovascular disease to refrain from using any tobacco or non-medical nicotine products.