[Nicotine Harms the Heart: No Safe Product, No Excuse for Political Inaction].

Nicotine is an independent and frequently underestimated cardiovascular risk factor. While prevention strategies have long focused on tobacco smoke and combustion products, current evidence clearly shows that nicotine itself is vasculotoxic, regardless of the delivery mode. Through sympathetic activation, blood pressure elevation, oxidative stress, endothelial dysfunction, and prothrombotic effects, nicotine drives the initiation and progression of cardiovascular disease. Most nicotine-associated mortality is cardiovascular and often occurs earlier than cancer outcomes. New nicotine products such as e-cigarettes, heat-not-burn devices, and oral nicotine pouches do not reduce this risk but increasingly shift exposure toward younger populations. A consistent, product-spanning early warning signal is the endothelial dysfunction, a validated predictor of future cardiovascular events, which is reversible only with complete nicotine abstinence. Unified, risk-based regulation of all nicotine-containing products is therefore a central pillar of effective cardiovascular prevention.