title: Chewing areca nut increases the risk of coronary artery disease in Taiwanese men: a case-control study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Long-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.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Wei-Chung
authors.initials: WC
authors.lastname: Tsai
authors.forename: Ming-Tsang
authors.initials: MT
authors.lastname: Wu
authors.forename: Guei-Jane
authors.initials: GJ
authors.lastname: Wang
authors.forename: Kun-Tai
authors.initials: KT
authors.lastname: Lee
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: Ye-Hsu
authors.initials: YH
authors.lastname: Lu
authors.forename: Hsueh-Wei
authors.initials: HW
authors.lastname: Yen
authors.forename: Chih-Sheng
authors.initials: CS
authors.lastname: Chu
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Chen
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Lin
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.forename: Po-Chao
authors.initials: PC
authors.lastname: Hsu
authors.forename: Kai-Hung
authors.initials: KH
authors.lastname: Cheng
authors.forename: Tsai-Hui
authors.initials: TH
authors.lastname: Duh
authors.forename: Ying-Chin
authors.initials: YC
authors.lastname: Ko
authors.forename: Sheng-Hsiung
authors.initials: SH
authors.lastname: Sheu
authors.forename: Wen-Ter
authors.initials: WT
authors.lastname: Lai
mesh_terms: D000328:Adult; D001114:Areca / Q000009:adverse effects*; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000209:etiology*; D006801:Humans; D008297:Male; D008409:Mastication; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013624:Taiwan