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[3] [4] One study states that smokeless tobacco use has a "positive effect on cardiovascular risk factors in young physically fit men." [5] However, it is important to note that one Indian study from the state of Rajasthan states, "There is a significantly greater prevalence of multiple cardiovascular risk factors [sic] obesity, resting tachycardia, hypertension, high total and LDL cholesterol, and low HDL cholesterol, and electrocardiographic changes in tobacco users, chewing or smoking, as compared-to tobacco non-users