SYSTEMIC HEALTH CONSEQUENCES OF SMOKELESS TOBACCO AND NOVEL ORAL NICOTINE PRODUCTS WITH A PARTICULAR FOCUS ON THE CARDIOVASCULAR SYSTEM: A NARRATIVE REVIEW

Bartłomiej Przystaś; Zuzanna Przybylska; Wiktor Rolski; Aleksandra Anna Purpura; Paulina Michalska; Mikołaj Piotr Hobot; Gabriela Patrycja Dobosz; Sebastian Podeszwa; Magdalena Grzechowiak

doi:10.31435/ijitss.2(50).2026.5589

Authors

Bartłomiej Przystaś Medical University of Silesia in Katowice, Poland https://orcid.org/0009-0009-6121-3839
Zuzanna Przybylska Medical University of Silesia in Katowice, Poland https://orcid.org/0009-0001-3329-4602
Wiktor Rolski Medical University of Silesia, Poland https://orcid.org/0009-0005-1439-4842
Aleksandra Anna Purpura Medical University of Silesia in Katowice, Poland https://orcid.org/0009-0006-3893-7730
Paulina Michalska Medical University of Silesia in Katowice, Poland https://orcid.org/0009-0007-4141-5906
Mikołaj Piotr Hobot Medical University of Silesia in Katowice, Poland https://orcid.org/0009-0001-2829-6005
Gabriela Patrycja Dobosz Medical University of Silesia in Katowice, Poland https://orcid.org/0009-0009-4012-9101
Sebastian Podeszwa Medical University of Silesia in Katowice, Poland https://orcid.org/0009-0000-2973-5324
Magdalena Grzechowiak Medical University of Silesia in Katowice, Poland https://orcid.org/0009-0001-8486-0352

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5589

Keywords:

Smokeless Tobacco, Nicotine Pouches, Cardiovascular System, Snus, Systemic Health, Public Health

Abstract

Background: Global nicotine consumption is shifting from cigarettes to alternative nicotine delivery systems (ANDS), specifically smokeless tobacco (ST) and oral nicotine pouches (NPs). Often marketed as "tobacco-free" and safer, these products deliver high nicotine doses, including synthetic forms, via the oral mucosa, bypassing traditional regulations and creating new public health challenges.

Aim: To synthesize scientific evidence on the systemic health consequences of ST and NPs, focusing on cardiovascular risks and long-term clinical outcomes.

Material and methods: A systematic search of electronic databases (PubMed, Scopus, Google Scholar) was conducted. Thirty-five peer-reviewed sources—comprising original research, systematic reviews, and longitudinal cohort studies—were analyzed using a qualitative synthesis approach.

Results: Pharmacokinetic data show that modern NPs achieve peak plasma levels and total exposure comparable to or exceeding cigarette smoking. Chronic use is linked to acute hemodynamic stress, increasing heart rate (10–15 bpm) and blood pressure (5–10 mmHg). Epidemiological studies indicate a heightened risk of fatal cardiovascular events, including myocardial infarction and stroke, with relative risks reaching 2.1 in younger cohorts. Furthermore, these products are associated with oral pathologies (recession, leukoplakia), adverse reproductive outcomes (fetal toxicity), and metabolic disorders like type 2 diabetes.

Conclusions: ST and NPs are not cardiovascularly inert; they exert significant sympathomimetic stress and pose substantial systemic risks. Their addictive potential and rising popularity among youth and athletes necessitate urgent regulatory oversight and a clinical focus on total nicotine cessation.

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