Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan

Abstract

ObjectivesAreca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. MethodsA prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. ResultsOf the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001). ConclusionsThe 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

Impact of habitual betel quid chewing on cardiovascular risk and outcomes: a systematic review

“…Additionally, even after adjusting for other risk factors such as diabetes and hypertension, betel quid users were seven times more likely to have CAD ((30). In those who were hospitalised following an acute coronary syndrome (ACS), the risk of re-hospitalisation in one month was twice that of non-betel quid users (aHR=2.05, 95% CI 1.29-3.27) and had higher 30-day mortality (aHR=2.72, 95% CI 1.73-4.26) (29). Furthermore, older individuals are at a higher risk of subclinical IHD compared to younger consumers of betel quid (26).…”

“…Thirteen studies were done in Taiwan (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), three studies done in Pakistan (29)(30)(31) and three studies in Bangladesh (32)(33)(34). There were nine crosssectional studies (16)(17)(18)20,(24)(25)(26)(27)31), seven prospective cohort studies (19,22,28,29,(32)(33)(34), two casecontrol studies (23,30) and one experimental design (21). Of the nine cross-sectional studies, eight were done in Taiwan (16)(17)(18)20,(24)(25)(26)(27) and one in Pakistan (31).…”

“…Of the nine cross-sectional studies, eight were done in Taiwan (16)(17)(18)20,(24)(25)(26)(27) and one in Pakistan (31). Of the seven prospective studies, three were done in Bangladesh (32)(33)(34), three in Taiwan (19,22,28)v and one in Pakistan (29). One case-control study was done in Pakistan (30), and one was done in Taiwan (23).…”

“…Four studies investigated the relationship between betel quid and ischemic heart disease. Two studies were conducted in Pakistan (29,30) and two in Taiwan (23,26). The results from all four studies indicate betel quid consumption is a risk factor for ischemic heart disease (IHD).…”

Impact of Smokeless Tobacco Use on Distribution of Vessel Involvement in Patients With Acute Myocardial Infarction

“…Previously, a study by Karim MT et al 16 Due to wide regional variations in formulation of smokeless tobacco products, research efforts on smokeless tobacco use in the context of coronary artery diseases also suffers from varying results. Such as Frobert O et al 18 conducted a registry based study in Swedish population to evaluate the risk of death and future cardiac events after PCI among snus (a regional smokeless tobacco product) users.…”