Abstract
BackgroundAreca nut chewing has been reported to be associated with obesity, metabolic syndrome, hypertension, and cardiovascular mortality in previous studies. The aim of this study was to examine whether chewing areca nut increases the risk of coronary artery disease (CAD) in Taiwanese men.MethodsThis study is a hospital-based case-control study. The case patients were male patients diagnosed in Taiwan between 1996 and 2009 as having a positive Treadmill exercise test or a positive finding on the Thallium-201 single-photon emission computed tomography myocardial perfusion imaging. The case patients were further evaluated by coronary angiography to confirm their CAD. Obstructive CAD was defined as a ≥ 50% decrease in the luminal diameter of one major coronary artery. The patients who did not fulfill the above criteria of obstructive CAD were excluded.The potential controls were males who visited the same hospital for health check-ups and had a normal electrocardiogram but no history of ischemic heart disease or CAD during the time period that the case patients were diagnosed. The eligible controls were randomly selected and frequency-matched with the case patients based on age. Multiple logistic regression analyses were used to estimate the odds ratio of areca nut chewing and the risk of obstructive CAD.ResultsA total of 293 obstructive CAD patients and 720 healthy controls, all men, were analyzed. Subjects who chewed areca nut had a 3.5-fold increased risk (95% CI = 2.0-6.2) of having obstructive CAD than those without, after adjusting for other significant covariates. The dose-response relationship of chewing areca nut and the risk of obstructive CAD was also noted. After adjusting for other covariates, the 2-way additive interactions for obstructive CAD risk were also significant between areca nut use and cigarette smoking, hypertension and dyslipidemia.ConclusionsLong-term areca nut chewing was an independent risk factor of obstructive CAD in Taiwanese men. Interactive effects between chewing areca nut and cigarette smoking, hypertension, and dyslipidemia were also observed for CAD risk. Further exploration of their underlying mechanisms is necessary.
Highlights
Areca nut chewing has been reported to be associated with obesity, metabolic syndrome, hypertension, and cardiovascular mortality in previous studies
After adjusting for age, educational levels, body mass index (BMI), diabetes mellitus (DM), HTN, dyslipidemia, cigarette smoking, and alcohol consumption, subjects who had ever chewed areca nut had an increasing risk of having obstructive coronary artery disease (CAD) (Table 2)
We found a dose-dependent relationship between areca nut chewing and CAD risk, as a higher amount of areca nut chewing was associated with a higher risk of obstructive CAD
Summary
Areca nut chewing has been reported to be associated with obesity, metabolic syndrome, hypertension, and cardiovascular mortality in previous studies. The aim of this study was to examine whether chewing areca nut increases the risk of coronary artery disease (CAD) in Taiwanese men. Previous studies have found that chewing areca nut is associated with obesity, metabolic syndrome, hypertension (HTN), and all-cause mortality [5,6,7,8,9]. A few epidemiological studies linked areca nut chewing with the risk of cardiovascular disease [9,10,11] Those studies were conducted in the community, their diagnosis of cardiovascular disease was based on a questionnaire or the report of the International Classification of Disease, Ninth Revision (ICD-9) codes 390-459. Since the habit of chewing areca nut is prevalent in Taiwanese men, we used the accurate method of diagnosed obstructive CAD to further examine the relationships between areca nut chewing and the risk of CAD in a Taiwanese male population
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