Cigarettes aren’t the only culprit; e-cigarettes and smokeless tobacco are harmful for hearts, too
by Rachael Joyner, DNP, FNP-BC, Duke Smoking Cessation Program
February is American Heart Month, an important time to champion actions to help people improve their heart health, especially since heart disease remains the leading cause of death for both men and women in the US. Tobacco use is one of the most important modifiable risk factors for heart disease. I work with patients awaiting heart transplants, so this is an issue that is near and dear to my heart.
We know that smoking cigarettes, using smokeless tobacco products, and vaping all increase the risk of cardiovascular disease. In my work as a Tobacco Treatment Specialist, I spend a lot of time countering myths and misconceptions related to tobacco use.
Here are the top 5 facts I share with patients on heart health and tobacco use:
1. Women who smoke are at higher risk. One in 5 women in the US. dies from heart disease. Compared to men who smoke, women who smoke are 25% more likely to develop heart disease.
2. E-cigarette use negatively impact heart health. The American Heart Association released a scientific report in 2023 detailing the harms of vaping on the cardiopulmonary system. Most e-cigarettes contain nicotine, which over time can lead to heart failure and abnormal heart rhythms. Nicotine also constricts blood vessels, leading to elevated blood pressure and delayed wound healing. Some of the non-nicotine components in e-cigarette smoke (flavorings, heavy metals) have been shown to cause heart and lung toxicity in animal and in vitro studies. Read more here.
3. Smoking marijuana increases your risk of heart attack and stroke. An estimated 10% of daily adult US smokers also use cannabis daily. This is definitely something I see a lot in my practice. A large observational study of more than 430,000 US adults found that daily cannabis use (largely through smoking) increased the risk of heart attack by 25% and stroke by 42%. Even weekly use increased these risks.
4. Smokeless tobacco use increases heart disease risk. Smokeless tobacco products, including nicotine pouches (think Zyn), contain nicotine. In addition to being addictive, long-term nicotine use can negatively impact cardiovascular health by causing spikes in heart rate and blood pressure. Studies have shown that smokeless tobacco product use increases the risk of death from heart disease and stroke. In contrast, nicotine replacement products (patch, gum, lozenges) release nicotine in a slow, controlled manner designed to be less addictive, and research has shown that they deliver much lower levels of nicotine to the body than tobacco products. More research is needed on the short-term and long-term health effects of nicotine pouches.
5. There is no safe level of tobacco. Even occasional or light smoking can increase your risk for heart disease. A large meta-analysis from 2018 showed that those smoking as little as one cigarette per day still had greatly increased heart attack and stroke risks. When compared to those smoking 20 cigarettes per day, the risk was only cut down by 40 to 50%. The risks were higher for women than men.
To learn more about helping your patients improve their heart health by quitting tobacco use, join our upcoming Comprehensive Tobacco Treatment Specialist Training Program. The next TTS training begins on February 24, 2025, and there are also summer and fall TTS sessions.
Visit www.dukeunctts.com for more information or to register.
About the Author
Rachael Joyner, DNP, FNP-BC, APRN, is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certification in Nicotine and Tobacco Treatment and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.
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