title: Betel nut chewing is associated with increased risk of cardiovascular disease and all-cause mortality in Taiwanese men.
abstract: BACKGROUND
  Betel nut chewing is related to several kinds of cancer, metabolic syndrome, and type 2 diabetes. Whether it is associated with a greater risk of cardiovascular disease (CVD) and all-cause mortality, however, remains unclear.
  
  
  OBJECTIVE
  We aimed to investigate the association between betel nut chewing and CVD and all-cause mortality.
  
  
  METHODS
  A baseline cohort of 56,116 male participants > or = 20 y old were recruited from 4 nationwide health screening centers in Taiwan in 1998 and 1999. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs) of CVD and all-cause mortality for betel nut chewers during an 8-y follow-up period.
  
  
  RESULTS
  There were 1549 deaths during the follow-up period, 309 of which were due to CVD. After adjustment for age, body mass index, diabetes, hypertension, lipids, smoking, alcohol consumption, physical activity, income, and education level, the RRs (95% CI) of CVD and all-cause mortality among the former betel nut chewers were 1.56 (1.02, 2.38) and 1.40 (1.17, 1.68), respectively, and those among current chewers were 2.02 (1.31, 3.13) and 1.40 (1.16, 1.70), respectively, compared with persons who had never chewed betel quid. Current and former betel nut chewers had a higher risk of CVD mortality (RR: 2.10; P < 0.05) than did current and former smokers. Greater frequency of betel nut chewing was associated with greater CVD and all-cause mortality.
  
  
  CONCLUSIONS
  Betel nut chewing was independently associated with a greater risk of CVD and all-cause mortality in Taiwanese men. Regular screening for betel nut chewing history may help prevent excess deaths in the future. An anti-betel nut chewing program is urgently warranted for current chewers.
authors.affiliation: Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Lin
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chiu
authors.forename: Long-Teng
authors.initials: LT
authors.lastname: Lee
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
authors.forename: Chih-Yang
authors.initials: CY
authors.lastname: Huang
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Huang
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D001114:Areca / Q000009:adverse effects / Q000737:chemistry; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008409:Mastication; D008875:Middle Aged; D009026:Mortality; D011159:Population Surveillance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013624:Taiwan
chemical_list: D002784:Cholesterol