title: Association between betel quid chewing and carotid intima-media thickness in rural Bangladesh.
abstract: BACKGROUND
  Areca nut, more commonly known as betel nut, is the fourth most commonly used addictive substance in the world. Though recent evidence suggests it may play a role in the development of cardiovascular disease, no studies have investigated whether betel nut use is related to subclinical atherosclerosis.
  
  
  METHODS
  We evaluated the association between betel nut use and subclinical atherosclerosis in 1206 participants randomly sampled from the Health Effects of Arsenic Longitudinal Study (HEALS). Frequency and duration of betel nut use were assessed at baseline, and carotid IMT was measured on average 6.65 years after baseline.
  
  
  RESULTS
  A positive association was observed between duration and cumulative exposure (function of duration and frequency) of betel nut use and IMT, with above-median use for duration (7 or more years) and cumulative exposure (30 or more quid-years) corresponding to a 19.1 μm [95% confidence interval (CI): 5.3-32.8; P ≤ 0.01] and 16.8 μm (95% CI: 2.9-30.8; P < 0.05) higher IMT in an adjusted model, respectively. This association was more pronounced in men [32.8 μm (95% CI: 10.0-55.7) and 30.9 μm (95% CI: 7.4-54.2)]. There was a synergy between cigarette smoking and above-median betel use such that the joint exposure was associated with a 42.4 μm (95% CI: 21.6-63.2; P ≤ 0.01) difference in IMT.
  
  
  CONCLUSIONS
  Betel nut use at long duration or high cumulative exposure levels is associated with subclinical atherosclerosis as manifested through carotid IMT. This effect is especially pronounced among men and cigarette smokers.
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
authors.forename: Tyler R
authors.initials: TR
authors.lastname: McClintock
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
authors.forename: Faruque
authors.initials: F
authors.lastname: Parvez
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
authors.forename: Fen
authors.initials: F
authors.lastname: Wu
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
authors.forename: Weijia
authors.initials: W
authors.lastname: Wang
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
authors.forename: Tariqul
authors.initials: T
authors.lastname: Islam
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
authors.forename: Alauddin
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
authors.forename: Ishrat
authors.initials: I
authors.lastname: Shaheen
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
authors.forename: Golam
authors.initials: G
authors.lastname: Sarwar
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Demmer
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USADepartments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USADepartments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, Unive
authors.forename: Moise
authors.initials: M
authors.lastname: Desvarieux
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
authors.forename: Habibul
authors.initials: H
authors.lastname: Ahsan
authors.affiliation: Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA yu.chen@nyumc.org.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001114:Areca; D001459:Bangladesh / Q000453:epidemiology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008409:Mastication; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*
keywords: Areca nut; Bangladesh; betel nut; cardiovascular disease; carotid intima-media thickness