The European Commission says it wants to protect Europeans from heart disease. That sounds good. Everyone agrees heart disease is a serious problem. But if you actually read the Commission’s new Safe Hearts Plan, it becomes clear very quickly that something is off. The document talks a lot about “nicotine,” but very little about the thing that actually causes cardiovascular damage: combustion.
And when policymakers confuse those two things, people die.
A Category Error at the Heart of the Plan
In the prevention chapter of the Safe Hearts Plan, the Commission groups nicotine pouches together with cigarettes, heated tobacco products, and e-cigarettes, and explicitly links them to future taxation under the revised Tobacco Taxation Directive.
That framing ignores the central driver of smoking-related cardiovascular disease: burning tobacco.
Cigarettes cause heart attacks and strokes because they expose users to carbon monoxide, fine particulate matter, and thousands of toxic combustion by-products that damage blood vessels and promote inflammation according to U.S. CDC.
Nicotine pouches do not burn, do not produce smoke, and do not expose users to carbon monoxide or combustion particulates.
Treating these products as equivalent is not a precautionary approach. It is a scientific error.
What Risk Assessments Actually Show
Independent risk assessments consistently reflect this difference. On comparative harm scales used in tobacco harm-reduction research, cigarettes score 100, while nicotine pouches score approximately 0.1, representing a 99.9% lower health risk compared to smoking.
This conclusion on supported by toxicological evidence showing that many nicotine pouch products contain no detectable tobacco-specific nitrosamines (TSNAs), the carcinogens strongly linked to smoking-related disease.
In other words, the products the Commission is targeting are not “low-risk cigarettes.” They are fundamentally different.
Real-World Evidence the Plan Ignores
This is not just theory. Real-world outcomes confirm the science.
Sweden, where smoke-free oral nicotine products are widely available and affordable, has the lowest daily smoking rate in the European Union, at approximately 5.3–5.6%.
Sweden’s tobacco-related mortality on approximately 44% lower than the EU average.
Sweden also has the lowest lung cancer incidence in Europe.
Source: European Cancer Information System (ECIS)
And Sweden reports lower rates of ischemic heart disease and stroke compared to many neighboring EU countries.
These outcomes were not achieved through bans or punitive taxation. They were achieved through risk-proportionate regulation that allowed smokers to move away from cigarettes.
Miksi tämä on tärkeää
When policymakers refuse to distinguish between products that burn and products that do not, the consequences are predictable.
Equal taxation of unequal products removes the price incentives that encourage smokers to switch away from cigarettes.
When safer alternatives become more expensive or less accessible, smoking rates decline more slowly and illicit markets expand.
A cardiovascular strategy that ignores these dynamics is not evidence-based. It is ideological.
A Simpler Way Forward
If the goal is to reduce heart disease, the science is clear. Combustion causes cardiovascular harm. Nicotine pouches do not involve combustion. Treating them like cigarettes may be administratively convenient, but it ignores evidence, real-world data, and basic public health logic.
If Europe wants fewer heart attacks, fewer strokes, and fewer smoking-related deaths, it has to stop pretending that all nicotine products are the same.
Risk-based regulation saves lives. Blunt regulation does not.
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