A Narrative Review of the Potential Impact of Next-Generation Tobacco and Nicotine Products on Cardiovascular Health

Cigarette smoking is a cause of serious disease in smokers, including cardiovascular disease (CVD). The processes underpinning the development of CVD are well understood. These involve many cell types and cellular processes contributing to the development of atherosclerotic plaques in blood vessels, leading to impaired tissue oxygen supply and acute manifestations such as myocardial infarction and stroke. Cigarette smoke contains thousands of chemicals, some of which can be harmful to the cardiovascular system and may promote atherogenesis. In this narrative review, we assess the growing body of evidence concerning the potential cardiovascular health impact of next‑generation tobacco and nicotine product (NGP) use, including electronic vaping product (EVP), heated tobacco product (HTP) and oral nicotine pouch (ONP) use. Exclusive use of NGPs substantially reduces exposure to harmful toxicants compared with cigarette smoking. Regarding CVD risk, we determine that: (i) in vivo and in vitro modelling studies demonstrate the potential for NGPs to reduce CVD risk compared with cigarette smoking; (ii) switching to the exclusive use of these products leads to reductions in biomarkers of exposure to cardiovascular toxicants and favourable changes in CVD risk-related biomarkers of potential harm; (iii) population‑level data show that switching to the exclusive use of both EVPs and HTPs is associated with reduced risk of CVD and related comorbidities compared with continued smoking, though data for ONPs in this area are lacking; and (iv) regulators are increasingly using science‑based evidence when approving marketing authorisations and the use of consumer‑facing reduced exposure claims. Overall, supporting the complete displacement of cigarettes with the use of NGPs has the potential to reduce CVD risk and improve both individual and population health.