Active and passive tobacco exposure during childhood and adolescence represents a critical preventable risk factor for premature cardiovascular disease, according to a new narrative review published in Trends in Cardiovascular Medicine. The article provides up-to-date evidence regarding the epidemiology, risk factors and clinical implications of active and passive smoking on a growing heart and discusses the prospective and likely causal relationships between tobacco exposure and structural and functional heart damage.
Summing up recent research, the authors also highlight some associations between tobacco smoking and cardiovascular morbidity and mortality over the life course. According to these data, smoking from childhood or adolescence significantly increased the risk of worsening functional and structural heart damage already in early adulthood, with a significant risk of heart attack and sudden cardiac death in mid-forties. Stopping tobacco smoking during mid-thirties significantly reduced the risk of death, but there was still an increased risk of heart failure three decades after smoking cessation.
The expert review was conducted by researchers from the Rutgers Robert Wood Johnson Medical School in the US, the University of Exeter in the UK, and the University of Eastern Finland.
The World Health Organization (WHO) recently reported that the number of global tobacco users has dropped from 1.38 billion in 2000 to 1.2 billion in 2024, but tobacco still causes millions of preventable deaths every year. In addition, recent surveillance data indicate that youth tobacco use has increased in 63 of 135 surveyed countries. A study among British youth reported that 60% of those who initiated smoking in childhood continued smoking at 24 years.
“Our review highlights an alarming trajectory: the cardiovascular consequences of smoking occur early after exposure, with cardiac damage observed decades before clinical symptoms manifest. Even secondhand smoke exposure, affecting 24 million non-smoking children in the US alone, causes structural cardiac damage. The pathophysiology involves complex metabolic dysregulation where smoking-induced muscle mass depletion, coupled with sedentary behavior patterns and poor dietary choices, creates a vicious cycle leading to increased cardiovascular alterations,” says the first author of the study, Dr Douglas Corsi, a resident doctor at the Rutgers Robert Wood Johnson Medical School in the US and a doctoral researcher at the University of Eastern Finland.
“Encouragingly, physical activity interventions can prevent children from initiating tobacco smoking and increase cessation success. Primordial prevention through policy measures, physical activity promotion and keeping nicotine products away from youth represents our most effective strategy to protect cardiovascular health for current and future generations,” Corsi concludes.
“WHO’s e-cigarette use statistics estimate 100 million vape users worldwide, of whom 15 million are between the ages of 13 and 15 years. This is a catastrophic degradation of the successes achieved in combatting tobacco in the last two decades. While e-cigarettes are marketed as a smoking cessation tool for adults, evidence suggests that adolescents are recreationally using vapes, which makes them four times more likely to initiate smoking as well. Scientific evidence is urgently needed on the long-term effects of vaping on youths’ health,” says the study’s senior author Andrew Agbaje, a physician and an associate professor (docent) of Clinical Epidemiology and Child Health at the University of Eastern Finland.
Agbaje’s research group (urFIT-child) is supported by research grants from Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, the Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, the Finnish Foundation for Cardiovascular Research, Ida Montin Foundation, Eino Räsänen Fund, Matti and Vappu Maukonen Fund, Foundation for Pediatric Research, Alfred Kordelin Foundation and Novo Nordisk Foundation.
For further information, please contact:
Andrew Agbaje, MD, MPH, PhD, FACC, FESC, FAHA, FNYAM, Cert. Clinical Research (Harvard), Associate Professor (Docent) of Clinical Epidemiology and Child Health, Principal Investigator (urFIT-child). Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland. [email protected], +358 46 896 5633
Honorary Research Fellow – Children's Health and Exercise Research Centre, Public Health and Sports Sciences Department, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK. [email protected]
Webpage: urFIT-child research group
Link to article:
Corsi DR, Agbaje AO. Impact of smoking from childhood associated with greater risk of cardiac damage. Trends Cardiovasc Med. Published online October 11, 2025. https://doi.org/10.1016/j.tcm.2025.10.002
Image: Epidemiologic life course pattern of tobacco smoking and cardiovascular morbidity and mortality.
