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Other potential adverse health effects of ST may include toxicity of the immune, reproductive and/or cardiovascular systems.[6,10,11,12,13] Cardiovascular disease (CVD) is the leading cause of death worldwide, responsible for over 17 million deaths globally and tobacco has been estimated to directly cause 10% of all CVD worldwide.[14,15,16] The epidemiological evidence on cigarette smoking in relation to CVD is compelling, but the relationships between CVD and smokeless types of tobacco, is limited and remains uncertain