J Prev Med Public Health.  2018 Mar;51(2):71-82. 10.3961/jpmph.17.189.

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

• Karim MT
• Inam S
• Ashraf T
• Shah N
• Adil SO
• Shafique K

• KMID: 2410865
• DOI: http://doi.org/10.3961/jpmph.17.189

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.

Keyword

Areca nut; Acute coronary syndrome; Mortality; Re-hospitalization; Pakistan

MeSH Terms

Acute Coronary Syndrome*
Areca*
Asia, Southeastern
Cardiovascular Diseases
Cohort Studies
Esophageal Neoplasms
Follow-Up Studies
Humans
Hypertension
Mass Screening
Mastication*
Mortality*
Nuts*
Pakistan*
Proportional Hazards Models
Prospective Studies