Impact of habitual betel nut chewing on cardiovascular risk and outcome: A systematic review.

ObjectivesHabitual betel quid chewing is a leading cause of oral cancer in Asia-Pacific countries where this practice is prevalent. While health policies have focused on countering betel quid chewing concerning cancer, current policies and health promotion strategies overlook the emerging link to adverse cardiovascular outcomes. This oversight could be due to inadequate studies demonstrating the association between betel quid chewing and cardiovascular risk. To address this gap, we conducted a systematic literature review and narrative synthesis of peer-reviewed published studies showing habitual betel quid use as a cardiovascular risk factor. MethodsWe searched PubMed for studies assessing betel quid chewing and its impact on cardiovascular health. We included primary research on human subjects. Next, we extracted data from eligible studies and stratified 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. We did not do a meta-analysis because of the different study designs, cardiovascular outcomes, and statistical measures. ResultsWe reviewed data from 19 studies that met the inclusion criteria. Habitual betel quid chewing is associated with ischemic heart disease, obstructive coronary artery disease, acute coronary syndrome, and re-hospitalisation following an acute coronary event. Additionally, betel quid use is a risk factor for atrial fibrillation and premature ventricular contractions. Long-term betel quid consumption was associated with elevated risks of all-cause mortality, cancer-related mortality, cardiovascular diseases, and cerebrovascular diseases. Moreover, habitual betel quid users had a higher overall cardiovascular risk. The regular use of betel quid was positively correlated with arterial wall stiffness and was independently associated with heart disease in women. Habitual betel quid use is associated with hypertension. ConclusionsHabitual betel quid chewing is an important cardiovascular risk factor in populations where the practice is prevalent.