Abstract
The emergence of new tobacco heating products and electronic nicotine delivery systems (ENDS) is changing the way humans are exposed to nicotine. The purpose of this narrative review is to provide a broad overview of published scientific literature with respect to the effects of nicotine on three key health-related areas: 1) cardiovascular risk, 2) carcinogenesis and 3) reproductive outcomes. These areas are known to be particularly vulnerable to the effects of cigarette smoke, and in addition, nicotine has been hypothesized to play a role in disease pathogenesis. Acute toxicity will also be discussed. The literature to February 2019 suggests that there is no increased cardiovascular risk of nicotine exposure in consumers who have no underlying cardiovascular pathology. There is scientific consensus that nicotine is not a direct or complete carcinogen, however, it remains to be established whether it plays some role in human cancer propagation and metastasis. These cancer progression pathways have been proposed in models in vitro and in transgenic rodent lines in vivo but have not been demonstrated in cases of human cancer. Further studies are needed to determine whether nicotine is linked to decreased fertility in humans. The results from animal studies indicate that nicotine has the potential to act across many mechanisms during fetal development. More studies are needed to address questions regarding nicotine exposure in humans, and this may lead to additional guidance concerning new ENDS entering the market.
Highlights
Developed tobacco and nicotine-containing products such as e-cigarettes are being widely accepted by consumers
In order to analyze any potential pathological roles of nicotine, there is a need to consider it in both isolation and within the new landscape of emerging tobacco heating products and electronic nicotine delivery systems (ENDS)
This review will provide an overview of the research up to February 2019, giving insight into the roles of nicotine in the development of acute toxicity, and discuss whether nicotine may adversely affect health in three specific areas: carcinogenesis, cardiovascular risk and reproduction
Summary
The authors state that “It is already understood that nicotine is not a major contributing factor to the diseases associated with tobacco smoking“ referring to (Benowitz et al, 1998; Gottlieb & Zeller, 2017; Royal College of Physicians, 2016). Gottlieb et al is a short commentary, itself not referring to any data supporting this statement It states "Nicotine is, responsible for getting smokers addicted to cigarette smoking in the first place - usually while they are children or young adults and their brains are still developing - and keeping them addicted long-term". Cardiovascular effects In the end the authors state “ there are immediate pharmacological effects of nicotine on cardiovascular parameters, there is little evidence to suggest that there is an increase in risk to long-term cardiovascular health as a result of nicotine exposure from either NRT or e-cigarettes.”.
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