(HealthDay News) -- Smokeless tobacco increases the risk of fatal heart attack and stroke, say researchers who reviewed the results of 11 studies conducted in North America and Sweden.

In recent decades, the researchers noted, the use of smokeless tobacco products has increased in Europe and North America, particularly among people younger than 40, partly because the products are promoted as safer alternatives to cigarettes.

However, their review found that users of smokeless tobacco products had a slightly higher risk of death from heart attack and stroke than non-users. Smokeless tobacco was linked with 0.5 percent of all heart attacks in the United States and 5.6 percent in Sweden, and 1.7 percent of all deaths from stroke in the United States and 5.4 percent in Sweden, according to the report in the Aug. 18 online edition of BMJ.

The increased risk is small, but the consistency of the results among the studies included in the review suggests that the findings are credible, according to the researchers, led by Dr. Paolo Boffetta, of the International Agency for Research on Cancer in France.

If the association between smokeless tobacco products and increased risk for fatal heart attack and stroke is proven, the public health and clinical implications could be substantial, they said in urging more studies into the issue.

More information

The U.S. National Cancer Institute has more about the health effects of smokeless tobacco.