September 2025. ETHRA submitted to the EU Cardiovascular Health Plan Call for Evidence.
Our submission is on behalf of the European Tobacco Harm Reduction Advocates (ETHRA).
ETHRA is the voice of 27 million EU consumers of safer nicotine products (SNPs). The safer nicotine products we use include vapes, nicotine pouches, snus, and heated tobacco products. ETHRA is a consortium of 24 grassroots consumer associations in 17 European countries, supported by experts in tobacco control and nicotine research. We are a voluntary operation with no industry funding or conflicts of interest. Our transparency registration number is 354946837243-73.
Focus policy on reducing tobacco smoking
Our focus is on the cardiovascular implications of tobacco and nicotine use. Our submission is focused on the cardiovascular (CVD) risks arising from smoking and the potential positive role of nicotine-containing smoke-free alternatives to smoking. We believe that most actions related to CVD (e.g., diet, exercise, and medical practice) should be undertaken at the member state level, and that the European Union does not have a strong mandate to address most of the behavioural and metabolic risks and remedies for CVD. The EU does, however, play a substantial role in tobacco and nicotine policy through the Tobacco Products Directive, the Tobacco Advertising Directive, the Tobacco Excise Directive, and the Council Recommendation on Smoke-Free Environments. It is essential, therefore, that its approach to tobacco and nicotine is grounded in sound science. Unfortunately, this is not currently the case.
The CVD risks arise primarily from smoking tobacco. Smoking is a significant modifiable risk factor for ischemic heart disease and stroke. According to the Global Burden of Disease (GBD) study, 156,444 CVD deaths were attributable to smoking and secondhand smoke exposure in the European Union in 2021. These deaths equate to 29.5% of the 529,826 smoking-attributable deaths and 9.5% of the 1,654,602 CVD-attributable deaths in the EU in 2021. Smoking is not the most significant behavioural risk factor at the population level (compared to diet), but for individuals who smoke, it is their most critical and modifiable risk factor.
Read the full submission (10 pages) here