Betel-Quid Chewing, Heart Failure, and Premature Ventricular Contractions in Patients with Cardiopulmonary Symptoms

Abstract

Betel-quid (BQ) is a commonly used psychoactive substance that renders a specific cardiotoxicity. The purpose of this study was to investigate the association between BQ chewing and premature ventricular contractions (PVC) in patients with cardiopulmonary symptoms, and examine the potential influences of cardiovascular and chronic diseases on such relationship. Participants were 146 patients with cardiopulmonary symptoms who participated in 24-h Holter electrocardiogram monitoring during 2012–2018 in a hospital serving residents that lived in a BQ high prevalence area. Data on substance uses and medical histories for cardiovascular and chronic diseases were collected. Baron–Kenny method was employed to evaluate possible mediation. In patients with cardiopulmonary symptoms, 36.3% were BQ users and 63.7% were nonusers. Adjusting for covariates, BQ chewing was significantly associated with heart failure and diabetes mellitus (adjusted odds ratio (aOR) = 3.4 and 2.3, respectively), but only heart failure was significantly correlated with a low and high level of PVC. Additionally controlling for the effect of heart failure, the risk of high PVC for BQ users reduced from 3.60 to 2.88; however, the risk for BQ chewers remained significant (95% CI: 1.06–7.84). Heart failure was found to explain 27.7% of the excessive effect of BQ use on high PVC. In conclusion, BQ use is directly associated with an elevated risk of high PVC in patients with cardiopulmonary symptoms. The higher risk might be elevated among patients who suffered heart failure. Given several research limitations, the findings from this study offer future opportunities for validation.

Safety and efficacy evaluation of Simo decoction and Arecae semen in herbal medicine practice

“…The consumption and medicinal use of Arecae Semen exhibit distinct levels of toxicity. Studies have demonstrated that the habitual chewing of edible Arecae Semen increases the risk of heart failure, ventricular premature beats, and oral cancer [ 32 , 70 ]. In contrast, the use of Arecae Semen in TCM often involves its combination with other herbal ingredients, as seen in Simo Mixture, where Arecae Semen is mixed with Muxiang, Zhike, Wuyao, and others, undergoing specific processing techniques.…”

The molecular mechanisms underlying arecoline-induced cardiac fibrosis in rats

“…Arecoline causes neurotoxicity through enhancement of oxidative stress and suppression of the antioxidant protective system [ 43 ]. Several studies have been reported that betel nut chewing induced cardiac dysrhythmias [ 28 , 44 ]. However, the molecular mechanisms in which arecoline-induced cardiac dysfunction is needed to be further elucidated.…”

“…The behavior of chewing areca nuts habitually has been found to cause cardiotoxicity, including coronary artery disease [ 27 ], heart failure, and premature ventricular contractions [ 28 ]. However, there is a lack of research investigating the effect of arecoline on cardiac fibrosis.…”

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

“…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).…”

“…Betel quid use is a risk factor for arrhythmias (24) and premature ventricular contractions (PVCs) (18). In a nationwide ecological study, Tsai et al (2013) found a positive correlation (r=0.558, p=0.07) between areca quid chewing and atrial fibrillation (AF).…”