The American Heart Association released a policy statement that examined cardiovascular risks associated with smokeless oral nicotine products, including both traditional and newer synthetic alternatives.

In the statement, published in Circulation, investigators found that these products, while less harmful compared with combustible tobacco, demonstrated potential adverse effects on cardiovascular disease (CVD) biomarkers and increased mortality risk in patients with preexisting heart conditions.

Swedish studies of snus users showed no increased CVD risk but indicated higher rates of fatal myocardial infarction and stroke. U.S. research identified elevated risks of CVD and strokes among smokeless tobacco users, though lower than cigarette smokers.

Usage data indicated that 2.1% of U.S. adults (n = 5.2 million individuals) and 1.2% of middle and high school students (n = 330,000) used smokeless oral nicotine products. Newer alternatives, particularly nicotine pouches, show increasing adoption among younger demographics.

The report noted the absence of cardiovascular risk data for newer synthetic nicotine products. While these products contained fewer tobacco-specific nitrosamines, their long-term health impacts remained unknown.

For clinical practice, the American Heart Association identified U.S. Food and Drug Administration–approved cessation methods as primary interventions, with smokeless products as potential alternatives among those unable to quit combustible tobacco through conventional approaches.

The organization outlined policy recommendations, including flavor restrictions, marketing regulations, and taxation strategies.

Conflict of interest disclosures can be found in the review article.