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We have concerns that nicotine from e-cigarettes could pose some risk for users with cardiovascular disease." [77] A 2018 Cochrane review found that, in rare cases, nicotine replacement therapy can cause non-ischemic chest pain (i.e., chest pain that is unrelated to a heart attack) and heart palpitations, but does not increase the incidence of serious cardiac adverse events (i.e., myocardial infarction, stroke, and cardiac death) relative to controls

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However, in nations such as Malaysia, rules require cartons to include at least 20 packets

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