Abstract
Smokeless tobacco (ST) differs from smoking and nicotine replacement therapy (NRT) in its composition and cardiovascular side effects. Although ST and smoking have relatively similar effects on addiction, weight, blood pressure, and heart rate, ST has much milder effects on metabolic syndrome, myocardial infarction, stroke, and cardiovascular mortality. On the other hand, NRT has less effect on heart rate and blood pressure and helps to treat nicotine addiction and decrease the weight gain resulting from quitting tobacco products. NRT is considered safer than smoking and ST. The nicotine load from ST is higher than that from smoking, but the burning in smoking causes the release of many substances that are more cardiovascularly toxic than nicotine, which explains the prominent metabolic and cardiovascular effects of smoking. Nicotine seems to have only a secondary role in the cardiovascular effects of smoking.