Smoking is bad for your heart. But what about smokeless tobacco? Researchers at the Cleveland Clinic Foundation in Ohio reviewed the evidence on this form of tobacco, which has become more popular in recent decades as smoking has declined.

What the researchers wanted to know: A 57-year-old man who'd quit smoking three years earlier came to see the doctor. He chewed as much as two cans of tobacco a day. He wanted to know what smokeless tobacco was doing to his heart disease risk, because he was worried that, if he quit chewing, he might go back to cigarettes.

What they did: The researchers used this occasion to review the research on smokeless tobacco and cardiovascular risk.

What they found: In general, studies suggest that smokeless tobacco users are better off than smokers, but have a higher risk for cardiovascular disease than people who don't use tobacco at all. For example, using smokeless tobacco can increase blood pressure, probably because it is high in sodium, nicotine, and licorice. (They say licorice increases blood pressure—who knew?) One study of nearly 3,000 men found that those who used smokeless tobacco had higher cholesterol levels. In a study of more than 130,000 Swedish construction workers, men who used smokeless tobacco were 1.4 times to die of cardiovascular problems than men who didn't use tobacco.

What the study means to you: The authors recommended that their patient quit using tobacco altogether.

Caveats: The researchers don't say if studies that found effects of smokeless tobacco on cholesterol and diabetes controlled for socioeconomic status.

Find out more: The National Institute of Dental and Craniofacial Research tells all about dip and chew with some nasty mouth pictures.

Read the article: Gupta, R., Gurm, H., and J.R. Bartholomew. "Smokeless Tobacco and Cardiovascular Risk." Archives of Internal Medicine. Sept. 27, 2004, Vol. 164, pp. 1845-1849.

Abstract online: http://archinte.ama-assn.org