title: Betel-quid use is associated with heart disease in women.
abstract: BACKGROUND
  Betel quid (Areca catechu) is used by approximately 10% of the world population. Betel-quid use is associated with the metabolic syndrome--a risk factor for heart disease.
  
  
  OBJECTIVE
  The objective was to test whether betel-quid use is associated with heart disease in adults.
  
  
  METHODS
  Nonpregnant adults aged 20-64 y (n=1932, 52% women) from the nationally representative Nutrition and Health Survey in Taiwan (1993-1996) were studied for independent associations between betel-quid use and heart disease after adjustment for lifestyle factors, age, obesity, diabetes mellitus, hypertension, and concentrations of serum total cholesterol and HDL cholesterol.
  
  
  RESULTS
  The prevalence of betel-quid use was higher in men than in women (31% compared with 2.4%; P<0.001). The prevalence of heart disease was not significantly different between men and women (3.3% compared with 2.3%; P=0.12). The prevalence of betel-quid use decreased, whereas the prevalence of heart disease increased, with age. Betel-quid users were younger, drank more, had a lower dietary fruit intake, had a higher Framingham risk score, and had higher serum triacylglycerol concentrations than did the nonusers. At a mean consumption rate of 10 times/d (the third quartile of betel-quid consumption in betel-quid users), betel-quid use was independently associated with the Framingham risk score in subjects without heart disease only if obesity was not included as an adjustment factor (P=0.007). Moreover, the daily rate of betel-quid use was independently associated with prevalent heart disease; the odds ratio associated with a betel-quid consumption rate of 10 times/d was 1.37 (95% CI: 1.1, 1.6; P=0.003) in women.
  
  
  CONCLUSIONS
  Betel-quid use is independently associated with heart disease in women.
authors.affiliation: Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Jinn-Yuh
authors.initials: JY
authors.lastname: Guh
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Jung-Fa
authors.initials: JF
authors.lastname: Tsai
authors.forename: Lea-Yea
authors.initials: LY
authors.lastname: Chuang
mesh_terms: D000328:Adult; D000367:Age Factors; D000375:Aging / Q000502:physiology; D001114:Areca / Q000009:adverse effects*; D005260:Female; D006306:Health Surveys; D006331:Heart Diseases / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology