79 twins were identified in which one was a smoker and the other a non-smoker, or there was one twin who had smoked at least five years longer than the other
Summary Table of Main Studies Key Sources & Further Reading Biomarkers of Toxicant Exposure Compared: NTR, 2025 UK Government Toxicology Review (PDF), 2022 Toxicological Evaluation of Nicotine Degradants: ACS Omega, 2025 BMJ: Levels of Nicotine and TSNAs in Oral Nicotine Pouches, 2024 Frontiers: Small Pouches, High Nicotine Doses, Lower Toxicants, 2024 PMC: Reduced in vitro Toxicity of Pouches vs Cigarettes, 2022 Conclusion Scientific consensus indicates that switching from cigarettes to nicotine pouches leads to dramatically lower exposure to most tobacco toxicants and combustion products
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This enabled us to investigate the effects on endothelial cells of substances in smoke/aerosol that are absorbed through the lungs and enter the bloodstream, and also any other circulating molecules that the body might produce in response to inhaling the smoke and/or aerosol, including proteins involved in the inflammatory response. The study included 120 adults, ages 21-50 years without cardiovascular disease