New research has revealed that being exposed to tobacco smoke during childhood or teenage years—either by smoking directly or being around others who smoke—can seriously harm the heart long before symptoms appear.
This review article, published in the journal Trends in Cardiovascular Medicine, shows that both active and passive smoking during youth is a major and preventable cause of early heart disease.
The researchers, from the U.S., U.K., and Finland, reviewed recent studies on how smoking affects a growing heart. They found that smoking from an early age causes changes in how the heart looks and functions.
These changes may not cause problems right away but can lead to major heart conditions, including heart attacks and sudden cardiac death, especially as early as the mid-40s.
Even when people quit smoking in their mid-30s, their risk of heart failure remains higher for decades. However, quitting still greatly reduces the risk of dying from smoking-related heart disease.
Secondhand smoke also poses serious dangers. In the U.S. alone, around 24 million children who don’t smoke are regularly exposed to tobacco smoke from others. These children are already at risk of heart damage, even if they’ve never smoked a single cigarette.
The damage from tobacco isn’t just from the smoke itself. The review explains that smoking causes complex disruptions in the body, including muscle loss and poor metabolism. Combined with unhealthy eating and a lack of exercise, this creates a cycle that increases the risk of heart disease.
The review’s lead author, Dr. Douglas Corsi, says this pattern is alarming because the heart problems start early, often decades before any symptoms show up.
He adds that promoting exercise and keeping nicotine products away from young people is one of the best ways to protect their hearts. Exercise not only boosts health but also makes it less likely that young people will start smoking.
Although tobacco use around the world is slowly decreasing—from 1.38 billion users in 2000 to 1.2 billion in 2024—it still causes millions of deaths every year. Worryingly, youth tobacco use is actually rising in many countries. One study in the U.K. found that 60% of people who started smoking as children were still smoking at 24 years old.
The situation with e-cigarettes is also concerning. The World Health Organization estimates that 100 million people use vapes globally, including 15 million teens aged 13 to 15. These devices are often promoted as tools to help adults stop smoking, but the evidence suggests many teens are using them for fun. Worse, teens who vape are four times more likely to start smoking regular cigarettes later.
Professor Andrew Agbaje, a senior author of the study, warns that we urgently need more research on how vaping affects young people’s long-term health. The increase in vaping among teens could undo much of the progress made in fighting tobacco over the past 20 years.
This research makes it clear that smoking and vaping aren’t just adult problems. The damage starts young, and so should the prevention. Policies that limit access to nicotine products, promote exercise, and educate young people about the risks of smoking and vaping are key to protecting heart health for generations to come.
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The study is published in Trends in Cardiovascular Medicine.
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