Abstract-All forms of tobacco lead to an increased risk of cardiovascular disorders. During the past few decades, the number of people who consume tobacco has increased worldwide because of an overall increase in the global population. It is estimated that close to 80% of the >1.3 billion people who smoke tobacco in the world are in low-and middle-income countries. Smokeless forms of tobacco are also widely consumed in low-and middle-income countries, including chewable and snuffed forms. Lack of targeted and effective strategies to control tobacco consumption contributes to a large burden of cardiovascular disorders in low-and middle-income countries, where cardiovascular disorders have become the leading cause of morbidity and mortality. In this review, we evaluate the epidemiology of tobacco use in low-and middle-income countries and assess the public health policies needed to control tobacco use in such regions for the prevention of cardiovascular disorders and other tobacco-related morbidities and mortality. Bidis and Kreteks Some of the smoked tobacco products are largely regionally specific. These products include bidis and kretes. Bidis are made of tobacco flakes wrapped in a nontobacco leaf (temburani or tendu) and are widely used in South Asia. 2 Flavoring ingredients are sometime added to bidis. Majority of bidis are manufactured in small cottage industries in South Asia. 16 Bidi smoking in India is more prevalent than manufactured cigarettes. [17][18][19] Bidi sales have not been subject to taxes and until recently they carried no health warnings. 20 Because of lower costs than manufactured cigarettes, bids are frequently smoked by poor people who have less education and are usually unaware of the health hazards associated with tobacco smoking. 17 Kreteks are largely produced in Indonesia and contain tobacco, clove buds, and a wide variety of additives (eg, caca, flavors). 21,22 Cloves contain eugenol, which acts as a local anesthetic in airways inducing more intense smoking than manufactured cigarettes. [23][24][25] Majority of kreteks have been machine made since the mechanization of the industry in the 1970s. 26 It is estimated that >90% of all smokers in Indonesia use kreteks. 27 Both bidis and kreteks are exported to other parts of the world including Europe and North America. 28 Studies examining smoking patterns, CO exposure, and nicotine delivery have found bidis and kreteks to differ little from manufactured cigarettes. 16,[29][30][31] Waterpipes There are various names by which waterpipes are known in different regions, including shisha, hookah, goza, and narghile. 32 Typical waterpipes combust tobacco (usually with the help of charcoal), and smoke is passed through a bowl of water before being inhaled through a hose. 32 A wide variety of products may be added along with tobacco for combustion, including hashish and other flavoring agents. 22 Despite a common association of waterpipe tobacco consumption with the Eastern Mediterranean region, waterpipe tobacco consumption is also high in ce...