Areca Nut Chewing and Risk of Atrial Fibrillation in Taiwanese Men: A Nationwide Ecological Study

Abstract

Background: Areca nut chewing is associated with the risk of obesity, metabolic syndrome, hypertension, and cardiovascular mortality. Although a few case reports or case series have suggested the link between areca nut chewing and cardiac arrhythmias, information about the relationship between areca nut chewing and atrial fibrillation (AF) is lacking. Thus, a nationwide ecological study was conducted to investigate this.Methods: Two national datasets, the nationwide population-based 2005 Taiwan National Health Insurance Research dataset (NHIRD) and the 2005 National Health Interview Survey (NHIS), were used for analyses. The clinical characteristics, inhabited area and medical histories for 375,360 eligible males were retrieved from the 2005 NHIRD. Health related behaviors including areca nut chewing, cigarette smoking, infrequent vegetable eating, and exercise habit were collected from the 2005 NHIS. The prevalence of AF and the areca nut chewing rate were evaluated by multivariate analysis.Results: Of the 375,360 males (mean age, 44 years old), 1,326 (0.35%) were diagnosed with AF. The higher areca nut chewing rate, the higher prevalence rate of AF in Taiwan (Spearman correlation coefficient r = 0.558, p = 0.007). After adjusting for other covariates, the current areca nut chewing rate was found to be independently associated with the prevalence of AF. The adjusted odd ratio for areca nut chewing was 1.02 (95% CI = 1.00-1.04) in risk of AF prevalence.Conclusions: Areca nut chewing is independently associated with the prevalence of AF in Taiwanese men. However, further exploration of the underlying mechanisms is necessary.

Risk of Bleeding and Stroke with Oral Anticoagulation and Antiplatelet Therapy in Patients with Atrial Fibrillation in Taiwan: A Nationwide Cohort Study

“…The date of diagnosis was defined as the index date. The accuracy of the ICD-9-CM codes for AF has been validated by medical chart review [ 20 ]; of patients who had an AF diagnosis by ICD-9-CM codes and used medications that might be prescribed to AF patients, 98% and 96% with AF recorded by either electrocardiogram or 24-hour Holter monitoring in a medical center and community teaching hospital, respectively. The exclusion criteria included the following: age at index date <18 years, patients who died during the index admission, patients with rheumatic heart disease (ICD-9-CM codes 393–398 in any one of the five positions on at least one inpatient claims or in any one of the three positions on at least two outpatient claims), and patients who died during the index admission.…”

Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation

“…First, because of its observational nature, bias attributable to unmeasured confounding could not be completely ruled out, although we used propensity score-matched analysis to balance major baseline comorbidities associated with stroke occurrence between cohorts. Second, the precision of the disease diagnoses, which was based on ICD-9-CM code from administrative data reported by physicians, may be a concern, although the diagnostic accuracy of the main events of interest, such as atrial fibrillation, [23][24][25] stroke, 27,28 and myocardial infarction, 29 and other important covariates, such as diabetes mellitus 35 or hypertension, 27 has been validated. Third, the cause of out-of-hospital death may be variable and uncertain without autopsy confirmation, whereas it is very unlikely to perform autopsies on patients with ESRD because they are more likely to die of cardiovascular disease.…”

“…To ensure accuracy, the diagnosis of AF was established based on 1 inpatient or 2 outpatient records of ICD-9-CM code 427.31 in the database, which has been validated. [23][24][25] Because the main aim of the present study was to investigate the risk of ischemic stroke in patients undergoing dialysis with new-onset nonvalvular AF, we excluded patients with diagnoses of AF before dialysis and those with histories of valvular heart disease. Patients without arrhythmia were included in the control cohort.…”

The Effects of Active and Passive Smoking and Cardiovascular Disease

“…A subgroup analysis of patients who continued smoking as compared to those who stopped showed that those who no longer smoked had reduced arrhythmia-induced mortality at one year; however, this finding was of marginal statistical significance. 80 The Atherosclerosis Risk in Communities (ARIC) study of 15,000 patients showed that the rate of smoking was a significant risk factor for AF, with hazard ratios (HR) of 1.32 (95% CI 1.10À1.57) in former smokers, 2.05 (95% CI 1.71À2.47) in current smokers, and 1.58 (95% CI 1.35À1.85) in people who had never smoked. 78 Smoking is a risk factor for nocturnal ventricular tachycardia in patients who have poor LV function.…”