The cigarette has long been identified as the villain of the piece ? symbol of the most potent threat posed by the tobacco industry.

But now, cardiologists are waking up to the more lethal intake of tobacco, in the form of pan masala and gutkha.

Cardiologists and experts on respiratory diseases and cancer have joined hands to press the alarm bell over the increasing use of tobacco in pouches, that has a more devastating effect than the puff.

Figures available with the state health department indicate that of all tobacco-users in Calcutta, or any other metro, only 30 per cent are smokers. The rest take tobacco in pan masala and gutkha.

In Calcutta, a survey among cardiac patients in five top hospitals suggests that around 75 per cent have a history of tobacco-chewing, not smoking.

In the past year, all the major private hospitals have seen a spurt in heart and lung patients, with a history of consuming non-cigarette tobacco.

A conservative estimate pegs the burden of tobacco-related diseases on the economy at Rs 28,000 crore.

?The anti-tobacco fight seems to centre around the cigarette industry, while the rest 70 per cent of the market, which poses a bigger threat, is largely ignored,? warned Kunal Sarkar, cardiac surgeon at Rabindranath Tagore International Institute of Cardiac Sciences. ?In fact, 60 per cent of the heart patients in Calcutta are chewing or consuming tobacco in the non-smoking form. If our focus is on disease prevention, the fight against tobacco is out-and-out partial and ineffective,? he added.

Going a step further, experts on respiratory diseases say almost 80 per cent of patients suffering from tobacco-related respiratory diseases have seldom touched cigarettes. The same applies for oral cancer patients, too.

?Chewing pan masala has become an urban habit, with more and more educated people taking to it. Non-cigarette tobacco is a big worry for all of us,? said Pavan Agarwal, expert on respiratory diseases.

Echoing him, Asok Sengupta, chest specialist at Apollo Gleneagles Hospital, added: ?Almost 70-80 per cent cases of respiratory diseases do not seem to have any links with cigarette-smoking.?

Doctors across the city share this concern. Ajay Kaul, cardiac surgeon at BM Birla Heart Research Centre, feels peripheral vascular disease (blood vessels of the leg getting clogged) and coronary artery disease (CAD) are becoming more common among tobacco users, thanks to the rampant consumption of pan masala.

?We are definitely worried over the disturbing trend emerging in the city,? Kaul added.

Of the various factors that were earlier thought to be the reasons for the spread of heart diseases, smoking was the foremost, followed by diabetes, high lipids, obesity, sedentary lifestyle and family history.

?But now, the other forms of tobacco are causing more harm to the human body, not just the heart. They are causing lung cancer, asthmatic disorders and gynaecological problems as well,? says cancer surgeon Gautam Mukhopadhyay.