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
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)
The results indicate that nicotine was not responsible for the cardiovascular profile of the participants, as changes were observed despite nicotine exposure remaining similar across all study groups
The results suggest that Endothelial progenitor cells (EPC) response to nicotine short-term may differ from the long-term effects, and acute studies in humans may not be representative of longer-term health effects
Summary
This narrative review was not carried out as a systematic review. The search results from PubMed omitted many well known and important studies, which were included from other sources. The PubMed search did not provide the majority of the literature cited. Future reviews on this topic should ideally be carried out systematically, using multiple sources. We cannot exclude the possibility that further relevant studies may not have been included
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