title: Is there any association between use of smokeless tobacco products and coronary heart disease in Bangladesh?
abstract: BACKGROUND
  Most epidemiological studies exploring the association between smokeless tobacco (SLT) use and coronary heart disease (CHD) have been in Western populations, and have focused on SLT products used in those countries. Few studies come from South Asian countries. Our objective was to determine the association between SLT use and CHD among non-smoking adults in Bangladesh.
  
  
  METHODS
  A matched case-control study of non-smoking Bangladeshi adults aged 40-75 years was conducted in 2010. Incident cases of CHD were selected from two cardiac hospitals. Community controls, matched to CHD cases, were selected from neighbourhoods, and hospital controls were selected from outpatient departments of the same hospitals. The Rose Angina Questionnaire (RAQ) was also used to re-classify cases and controls.
  
  
  RESULTS
  The study enrolled 302 cases, 1,208 community controls and 302 hospital controls. Current use was higher among community controls (38%) compared to cases (33%) and hospital controls (32%). Current use of SLT was not significantly associated with an increased risk of CHD when community controls were used (adjusted OR 0.87, 95% CI 0.63-1.19), or when hospital controls were used (adjusted OR 1.00, 95% CI 0.63-1.60), or when both control groups were combined (adjusted OR 1.00, 95% CI 0.74-1.34). Risk of CHD did not increase with use of individual types except gul, frequency, duration, past use of SLT products, or using the RAQ to re-classify cases and controls. There was a significant association between gul use and CHD when both controls were combined (adjusted OR 2.93, 95% CI 1.28-6.70).
  
  
  CONCLUSIONS
  There was no statistically significant association between SLT use in general and CHD among non-smoking adults in Bangladesh. Further research on the association between gul use and CHD in Bangladesh along with SLT use and CHD in other parts of the subcontinent will guide public health policy and interventions that focus on SLT-related diseases.
authors.affiliation: Discipline of Public Health, The University of Adelaide, Adelaide, Australia. aziz.rahman@adelaide.edu.au
authors.forename: Muhammad Aziz
authors.initials: MA
authors.lastname: Rahman
authors.forename: Nicola
authors.initials: N
authors.lastname: Spurrier
authors.forename: Mohammad Afzal
authors.initials: MA
authors.lastname: Mahmood
authors.forename: Mahmudur
authors.initials: M
authors.lastname: Rahman
authors.forename: Sohel Reza
authors.initials: SR
authors.lastname: Choudhury
authors.forename: Stephen
authors.initials: S
authors.lastname: Leeder
mesh_terms: D000328:Adult; D000368:Aged; D001459:Bangladesh / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014030:Tobacco, Smokeless / Q000009:adverse effects*