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Nicotine and Cardiovascular Health: When Poison is Addictive – a WHF Policy Brief Cover

Figures & Tables

Table 1

Chemical information for nicotine in different forms.

COMMON CHEMICAL NAMESUNIQUE IDENTIFIER: CAS REGISTRY NUMBERS*ORIGIN
(S)-nicotine / (S)-(-)- nicotine / (-)-nicotine54-11-5
  1. Tobacco plant (S > 90%; R < 5%)

  2. Chemically synthesized

(R, S)-nicotine mixture / (±)-nicotine22083-74-5
(R)-nicotine / (R)-(+)-nicotine / (+)-nicotine25162-00-9

[i] * A Chemical Abstracts Service Registry Number is a unique numerical identifier assigned to a specific chemical substance [35].

Table 2

Effects of nicotine on cardiovascular parameters and risk factors.

PARAMETERSEFFECTS OF NICOTINEPOTENTIAL COMPLICATIONS
Heart rateIncreaseAcute tachycardia
Blood pressureIncreaseAcute hypertension
Coronary vasodilator reserveDecreaseMyocardial ischemia (chest pain)
Action on blood vesselsHypertension
Cutaneous vesselsVasoconstriction
Skeletal musclesVasodilatation
Peripheral vascular resistanceIncrease
Blood viscosityIncreaseThrombosis
Platelet aggregationIncreaseThrombosis
Production and release of nitric oxideDecreaseEndothelial dysfunction
Total and LDL cholesterol levelsIncreaseAccelerated atherosclerosis
Insulin resistanceIncreaseMacrovascular complications
MEASURESOBJECTIVES
All people, particularly those with cardiovascular risk factors or disease, should refrain from using tobacco and non-medical nicotine products.
  • To prevent first and recurrent cardiovascular events in people living with cardiovascular risk factors or disease.

  • To prevent nicotine addiction and increased risks of health harms.

Educators and community leaders should raise public awareness, particularly through educational activities dedicated to special populations: adolescents, young adults, and women.
  • To prevent and reduce nicotine addiction.

  • To reduce the number of young patients with cardiovascular diseases.

  • To reduce the number of pregnant smokers.

  • To reduce second-hand exposure to tobacco smoke and ENDS aerosols.

  • To increase community and political support for regulatory measures.

All health care providers should systematically recommend tobacco cessation and provide tobacco cessation services or referrals to patients as standard of care.
  • To free patients from nicotine addiction and reduce their risks of tobacco-related diseases and their clinical complications.

  • To reduce the tobacco-related socio-economic burden of disease.

The health care community, civil society, and public should constantly call on governments to implement and enforce regulatory measures that protect public health from tobacco and non-medical nicotine products and from the vested interests of the tobacco industry.
  • To protect and promote the highest standards of health for all people of all ages.

  • To ensure that tobacco regulatory policies are not weakened or influenced by the tobacco industry.

MEASURESOBJECTIVES
Researchers should study the long-term effects of ENDS, HTP, and other newer recreational nicotine products on cardiovascular health.
  • To close the knowledge gap on the long-term effects of newer tobacco and recreational nicotine products on cardiovascular health.

Researchers should further probe the drivers of disparities in nicotine and tobacco product use globally and within vulnerable or marginalized communities in a country.
  • To better understand how to apply tobacco control measures more effectively in order to curb the burden of tobacco uptake and use among more vulnerable populations.

All researchers, academic institutions, and medical and scientific journals should reject tobacco industry collaboration and refrain from publishing and/or presenting studies funded by the tobacco industry.
  • To prevent tobacco industry interference and promotion of tobacco industry interests.

  • To address conflicts of interest and biased studies.

  • To ensure scientific integrity.

MEASURESRATIONALE
Regulate by prohibiting or restricting the production, distribution, marketing, sale, and use of tobacco and recreational nicotine products.
  • To improve people’s health by eliminating or reducing their use of tobacco and recreational nicotine products by implementing measures that prevent initiation, promote and support cessation, and discourage consumption of such products.

Require manufacturers of tobacco and nicotine products to provide evidence of safety of their products.
  • To prevent and reduce health harms and injuries from use of harmful products.

Regulate the amounts of nicotine delivered by tobacco and nicotine products, including delivery devices.
  • To reduce nicotine concentration and delivery and thereby limit the addiction potential of tobacco and nicotine products and their related adverse health effects.

  • To implement and reinforce Articles 9 and 14 of the WHO FCTC.

Introduce or strengthen pro-health excise taxes for tobacco and non-medical nicotine products.
  • To increase the prices and reduce the affordability of tobacco and non-medical nicotine products, and thereby discourage and reduce their consumption, especially by youths.

  • To raise additional income for governments and the promotion of health.

  • To implement and reinforce Article 6 of the WHO FCTC.

Require standardized packaging with pictorial health warnings and appropriate labelling on tobacco and nicotine products.
  • To reduce the appeal of tobacco and nicotine products, especially among youth.

  • To reduce exposure to marketing strategies through packaging.

  • To warn consumers about the dangers of tobacco and nicotine.

  • To implement and reinforce Articles 11, 12, and 13 of the WHO FCTC.

Prohibit the addition of flavouring agents in all tobacco and recreational nicotine products, including ENDS.
  • To reduce the appeal of tobacco and nicotine products, especially among youth.

  • To prevent the consumption of substances that may be harmful and unsafe for inhalation.

  • To simplify the regulation of e-cigarette solutions.

  • To implement and reinforce Article 9 of the WHO FCTC.

Prohibit the use of aerosol-generating tobacco and nicotine products in indoor public places, workplaces, and public transports.
  • To protect the public from exposure to second-hand tobacco and nicotine aerosols.

  • To implement and reinforce Article 8 of the WHO FCTC.

Prohibit and monitor all direct and indirect advertising, promotion, and sponsorship of tobacco and recreational nicotine products.
  • To reduce exposure to marketing strategies that encourage tobacco and recreational nicotine product consumption, including at points of sale and on the internet.

  • To implement and reinforce Articles 5.3 and 13 of the WHO FCTC.

Prohibit and monitor the dissemination of misleading claims on the health effects of tobacco and recreational nicotine products.
  • To prevent misleading claims that may encourage the consumption of potentially harmful products.

  • To prevent misleading claims on the addictive nature of nicotine and on the effectiveness of newer products as tobacco cessation tools.

  • To implement and reinforce Articles 5.3, 11 and 13 of the WHO FCTC.

Regulate the supply of and retail access to tobacco and nicotine products.
  • To limit and reduce the availability of tobacco and nicotine products, especially to young people.

  • To reduce exposure to marketing strategies at point of sale.

DOI: https://doi.org/10.5334/gh.1292 | Journal eISSN: 2211-8179
Language: English
Submitted on: Nov 17, 2023
Accepted on: Dec 28, 2023
Published on: Jan 31, 2024
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2024 E. Ulysses Dorotheo, Monika Arora, Amitava Banerjee, Eduardo Bianco, Nuan Ping Cheah, Regina Dalmau, Thomas Eissenberg, Koji Hasegawa, Pamela Naidoo, Noreen T. Nazir, L. Kristin Newby, Nour Obeidat, Andrii Skipalskyi, Janina Stępińska, Jeffrey Willett, Yunshu Wang, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.