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On-line Access: 2010-09-08

Received: 2010-04-10

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Crosschecked: 2010-08-17

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Journal of Zhejiang University SCIENCE B 2010 Vol.11 No.9 P.681-689

http://doi.org/10.1631/jzus.B1000132


Chewing substances with or without tobacco and risk of cardiovascular disease in Asia: a meta-analysis


Author(s):  Li-na Zhang, Yun-mei Yang, Zhe-rong Xu, Qi-feng Gui, Qin-qing Hu

Affiliation(s):  Department of Gerontology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China, Department of Nephrology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China

Corresponding email(s):   yunmei_yang.zju@hotmail.com

Key Words:  Cardiovascular disease, Areca catechu, Betel quid, Chewing tobacco, Relative risk, Meta-analysis


Li-na Zhang, Yun-mei Yang, Zhe-rong Xu, Qi-feng Gui, Qin-qing Hu. Chewing substances with or without tobacco and risk of cardiovascular disease in Asia: a meta-analysis[J]. Journal of Zhejiang University Science B, 2010, 11(9): 681-689.

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author="Li-na Zhang, Yun-mei Yang, Zhe-rong Xu, Qi-feng Gui, Qin-qing Hu",
journal="Journal of Zhejiang University Science B",
volume="11",
number="9",
pages="681-689",
year="2010",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1000132"
}

%0 Journal Article
%T Chewing substances with or without tobacco and risk of cardiovascular disease in Asia: a meta-analysis
%A Li-na Zhang
%A Yun-mei Yang
%A Zhe-rong Xu
%A Qi-feng Gui
%A Qin-qing Hu
%J Journal of Zhejiang University SCIENCE B
%V 11
%N 9
%P 681-689
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%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1000132

TY - JOUR
T1 - Chewing substances with or without tobacco and risk of cardiovascular disease in Asia: a meta-analysis
A1 - Li-na Zhang
A1 - Yun-mei Yang
A1 - Zhe-rong Xu
A1 - Qi-feng Gui
A1 - Qin-qing Hu
J0 - Journal of Zhejiang University Science B
VL - 11
IS - 9
SP - 681
EP - 689
%@ 1673-1581
Y1 - 2010
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1000132


Abstract: 
Objective: To assess whether people who ever use any form of chewing substance in Asia are at increased risk of cardiovascular disease (CVD). Methods: PubMed and ISI Web of Science were searched for relevant studies, with no limitation on language or study year. Studies were included if they provided quantitative estimate of the association between ever use of chewing substance and the occurrence of CVD. Two authors independently implemented inclusion criteria, abstracted study characteristics, and performed meta-analysis. Summary relative risks were estimated on the basis of a random effect model. We used Q statistic and Egger’s test to examine heterogeneity across studies and potential publication bias, respectively. Results: Eight eligible studies were included. The relative risk of CVD for ever using chewing substances with or without tobacco was 1.26 (95% confidence interval (CI) 1.12–1.40), which was unchanged when restricted to cohort studies [1.25 (1.08–1.42)] or cohort studies in Taiwan [1.31 (1.12–1.51)]. The summary relative risk for ischemic heart disease was 1.27 (1.02–1.52), and was lowered to 1.26 (0.85–1.67) after exclusion of a cross-sectional study. The overall relative risk for cerebrovascular disease was 1.32 (1.08–1.56). On the basis of the Taiwan data, the summary relative risk of CVD for betel (Areca catechu) chewing was 1.30 (1.17–1.44). Data on dose-response were limited to betel chewing in Taiwan, suggesting a relationship between risk of CVD and cumulative exposure. Two large cohorts in Taiwan reported a greater risk of CVD with betel chewing than with smoking. Conclusions: An association was detected between betel chewing with or without tobacco and the risk of CVD. Betel chewing may impose a greater CVD risk than smoking. More effort is needed in developing betel chewing cessation programmes. The relationship between betel chewing and subgroups of CVD requires further investigation.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

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