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Itaki R, Taufa S. Association between habitual betel quid chewing and risk of adverse cardiovascular outcomes: A systematic review. Trop Med Int Health 2024; 29:447-453. [PMID: 38556799 DOI: 10.1111/tmi.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Habitual betel quid chewing, a tobacco product, is a leading cause of oral cancer in Asia-Pacific countries where this practice is most prevalent. However, it is not well understood whether betel quid chewing is also a cause of adverse cardiovascular outcomes. To address this gap, we conducted a systematic literature review of peer-reviewed published studies evaluating the association between habitual betel quid use on the risk of adverse cardiovascular outcomes. METHODS We searched PubMed for studies assessing the correlation between betel quid chewing and cardiovascular health. We included studies if (i) they included human subjects; (ii) were peer-reviewed articles in indexed journals; and (iii) were in English. We extracted data from eligible studies and stratified them by geographical location, study designs and cardiovascular outcomes. Finally, we did a narrative synthesis of the data to identify adverse cardiovascular outcomes associated with chronic betel quid use. FINDINGS We reviewed data from 19 studies that met the inclusion criteria. Habitual betel quid chewing was associated with hypertension, atherosclerosis, inflammation and ischaemic heart disease. In addition, betel quid use was a risk factor for arrhythmias. Interestingly, betel quid use was an independent risk factor for cardiovascular disease in women. Long-term betel quid consumption was associated with higher risks for all-cause mortality and increased overall cardiovascular risk. CONCLUSIONS Habitual betel quid chewing is an important cardiovascular risk factor in populations where the practice is prevalent.
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Affiliation(s)
- Rodney Itaki
- American Samoa Government, Department of Public health, Pago Pago, American Samoa, USA
| | - Shalon Taufa
- Department of Basic Medical Sciences, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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Lin WY, Tsai BCK, Day CH, Chiu PL, Chen RJ, Chen MYC, Padma VV, Luk HN, Lee HC, Huang CY. Arecoline induces heart injure via Fas/Fas ligand apoptotic pathway in heart of Sprague-Dawley rat. ENVIRONMENTAL TOXICOLOGY 2021; 36:1567-1575. [PMID: 33929070 DOI: 10.1002/tox.23153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/21/2021] [Accepted: 04/17/2021] [Indexed: 06/12/2023]
Abstract
Habitual chewing of areca nut increases the risk of cardiovascular disease mortality, but less report demonstrate the toxic mechanism of areca nut on heart. To investigate toxicity of areca nut on cardiomyocytes, we induced the heart injury with arecoline to evaluate the acute damage of areca nut on heart. Different concentrations of are coline (lowdosage: 5 mg/kg/day and high dosage 50 mg/kg/day) were injected into Sprague-Dawley rat via intra-peritoneal method for 21 days to create negative effects of arecoline on cardiomyocyte. Themyocardial architecture of the rat heart was observed. The arecoline-induced apoptotic proteins were analysed via western blotting. The myocardialarchitecture of heart was injured with arecoline and TUNEL stain was also shown are coline-induced cardiac apoptosis. Arecoline promoted the protein expression of both Fas dependent snd mitochondrial dependent apoptosis. In summary, arecoline induces cardiac toxicity and apoptosis by inducing both death receptor and mitochondria-dependent apoptotic pathways on heart.
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Affiliation(s)
- Wen-Yuan Lin
- The Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Bruce Chi-Kang Tsai
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | | | | | - Ray-Jade Chen
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Michael Yu-Chih Chen
- Department of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - V Vijaya Padma
- Department of Biotechnology, Bharathiar University, Coimbatore, India
| | - Hsiang-Ning Luk
- Department of Anesthesia, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Hsiang-Chen Lee
- Department of Anesthesia, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chih-Yang Huang
- Cardiovascular and Mitochondrial Related Disease Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
- Center of General Education, Buddhist Tzu Chi Medical Foundation, Tzu Chi University of Science and Technology, Hualien, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Karim MT, Inam S, Ashraf T, Shah N, Adil SO, Shafique K. Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan. J Prev Med Public Health 2018; 51:71-82. [PMID: 29631348 PMCID: PMC5897234 DOI: 10.3961/jpmph.17.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/12/2018] [Indexed: 02/05/2023] Open
Abstract
Objectives Areca 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. Methods A 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. Results Of 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). Conclusions The 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.
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Affiliation(s)
- Muhammad Tariq Karim
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
| | - Sumera Inam
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
| | - Tariq Ashraf
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
| | - Nadia Shah
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
| | - Syed Omair Adil
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
| | - Kashif Shafique
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
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Tseng CH. Sitagliptin and oral cancer risk in type 2 diabetes patients. Oncotarget 2017; 8:96753-96760. [PMID: 29228568 PMCID: PMC5722520 DOI: 10.18632/oncotarget.18239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/14/2017] [Indexed: 12/12/2022] Open
Abstract
The reimbursement database of the Taiwan’s National Health Insurance was used to evaluate oral cancer risk after sitagliptin use. Patients newly diagnosed of type 2 diabetes during 1999–2008 were recruited. A 1:1 propensity score matched-pair sample of 39195 ever users and 39195 never users were followed up until December 31, 2011. Cox regression incorporated with the inverse probability of treatment weighting using propensity score was used to estimate hazard ratios. Results showed that the overall hazard ratio was not statistically significant (0.956, 95% confidence interval: 0.652–1.401). However, in tertile analyses, the hazard ratio for the first (< 7.47 months), second (7.47–15.63 months) and third (> 15.63 months) tertile of cumulative duration was 1.563 (0.963–2.537), 1.236 (0.738–2.071) and 0.345 (0.164–0.725), respectively; and was 1.575 (0.963–2.575), 1.224 (0.738–2.033) and 0.347 (0.165–0.731), respectively, for the first (< 19,600 mg), second (19,600–42,200 mg) and third (> 42,200 mg) tertile of cumulative dose. Sensitivity analyses after excluding patients who developed any other cancer during follow-up did not change the results substantially. Additionally, the risk of oral diseases that may predispose to oral cancer (i.e., “gingival and periodontal diseases" and/or "oral mucosal lesions") paralleled the risk pattern of oral cancer, suggesting a possible explanation for the risk change of oral cancer related to sitagliptin. In conclusion, sitagliptin may reduce oral cancer risk when the cumulative duration is > 15.63 months or the cumulative dose is > 42,200 mg.
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Affiliation(s)
- Chin-Hsiao Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Division of Environmental Health and Occupational Medicine of the National Health Research Institutes, Zhunan, Taiwan
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Metformin may reduce oral cancer risk in patients with type 2 diabetes. Oncotarget 2016; 7:2000-8. [PMID: 26683519 PMCID: PMC4811512 DOI: 10.18632/oncotarget.6626] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 11/21/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Whether metformin use may affect the risk of oral cancer required further investigation. METHODS The reimbursement database of the National Health Insurance in Taiwan was used. Patients with type 2 diabetes mellitus at an onset age of 25-74 years during 1999-2005 and newly treated with either metformin (n = 288198, "ever users of metformin") or other antidiabetic drugs (n = 16263, "never users of metformin") were followed for at least 6 months for oral cancer until December 31, 2011. The treatment effect of metformin (for ever versus never users, and for tertiles of cumulative duration of therapy) was estimated by Cox regression adjusted for propensity score (PS) or incorporated with the inverse probability of treatment weighting (IPTW) using PS. RESULTS The respective numbers of incident oral cancer in ever users and never users were 1273 (0.44%) and 119 (0.73%), with respective incidences of 92.7 and 163.6 per 100,000 person-years. The overall hazard ratios (95% confidence intervals) suggested a significantly lower risk [0.584 (0.483-0.707) for PS-adjusted model, and 0.562 (0.465-0.678) for IPTW model]. In tertile analyses, the PS-adjusted hazard ratios (95% confidence intervals) for the first (<21.5 months), second (21.5-45.9 months) and third (>45.9 months) tertile of cumulative duration were 1.403 (1.152-1.708), 0.557 (0.453-0.684) and 0.152 (0.119-0.194), respectively; and were 1.244 (1.024-1.511), 0.526 (0.429-0.645) and 0.138 (0.108-0.176), respectively, for IPTW. CONCLUSIONS Metformin may significantly reduce the risk of oral cancer, especially when the cumulative duration is more than 21.5 months.
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Oral cancer in Taiwan: is diabetes a risk factor? Clin Oral Investig 2012; 17:1357-64. [PMID: 22895832 DOI: 10.1007/s00784-012-0820-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 08/01/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The association between diabetes and oral cancer is rarely studied. We investigated the trends of oral cancer in the Taiwanese general population and the possible link with diabetes. MATERIALS AND METHODS The trend of age-standardized oral cancer incidence in 1979-2007 in Taiwan was calculated from the Taiwan Cancer Registry database. A total of 494,817 men and 503,723 women without oral cancer from a random sample of 1,000,000 individuals covered by the National Health Insurance were followed up from 2003 to 2005. Cox regression evaluated the adjusted relative risk considering potential detection bias and covariates. RESULTS The trends increased significantly in both sexes. Diabetic patients had a higher chance of oral cancer detection because they more frequently visited related medical professionals. Although diabetes status and duration were significantly associated with oral cancer in unadjusted models, none was significant after multivariable adjustment. For comorbidities, chronic obstructive pulmonary disease (a surrogate for smoking) and alcohol-related diagnoses were significant for men, and hypertension and alcohol-related diagnoses were significant for women. Additionally, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and insulin were significant with relative risk (95 % confidence interval) of 1.642 (1.174-2.295) and 2.136 (1.003-4.547), respectively, in men. CONCLUSIONS Oral cancer is increasing in Taiwan. Diabetes is not a risk factor after multivariable adjustment. CLINICAL RELEVANCE The increasing trend of oral cancer may not be ascribed to diabetes. The association between oral cancer and some comorbidities and medications requires confirmation and may provide strategies for the prevention of oral cancer.
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Mateen FJ, Carone M, Alam N, Streatfield PK, Black RE. A population-based case-control study of 1250 stroke deaths in rural Bangladesh. Eur J Neurol 2012; 19:999-1006. [PMID: 22340663 DOI: 10.1111/j.1468-1331.2012.03666.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE There are limited population-based studies to determine the risk factors for stroke in Bangladesh. METHODS A health and demographic surveillance system has been maintained in Matlab, Bangladesh (population 223 886, 142 villages in 2008). All adult stroke and injury deaths (2005-2008) were monitored by verbal autopsy. Risk factors for stroke deaths were calculated using a multivariable logistic regression model with adult injury deaths as controls. RESULTS A total of 1250 stroke deaths (51% women; mean age 72.3 years, range 20-101) occurred out of 4955 total deaths and were compared with 246 adult injury deaths (47% women, mean age 55.8 years, range 20-100). The population-attributable mortality of stroke was 25.2% based on the verbal autopsy instrument and 17.8% when accounting for the reported sensitivity and specificity of a similar verbal autopsy instrument that has been validated for stroke death. Risk of stroke death was significantly increased with hypertension (OR 7.94, 95% CI 4.44-15.54, P < 0.001), diabetes mellitus (OR 2.54, 1.21-6.21, P = 0.02), and betel consumption (OR 2.36, 1.45-3.80, P < 0.001) when adjusted for age and sex. An increased risk was not observed with heart disease (OR 1.37, 0.45-5.95, P = 0.62), cigarette smoking (OR 1.41, 0.82-2.45, P = 0.22), tobacco powder (OR 1.15, 0.30-7.64, P = 0.86), or cigar/hookah pipe smoking 0.94 (0.45-2.18, P = 0.88) when adjusted for age and sex. There were more strokes in winter (December-March) than summer (June-September) (P < 0.001). CONCLUSIONS There is a high modifiable burden of risk factors for adult stroke deaths in rural Bangladesh, most notably including hypertension. Betel consumption may be an under-recognized risk factor for stroke death.
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Affiliation(s)
- F J Mateen
- Department of International Health, Bloomberg School of Public Health, 600North Wolfe Street, Baltimore, MD 21287, USA.
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