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Association of tobacco and betel nut chewing and cardiovascular disease.


The article written by Ahmed et al. [1] was read with curiosity. The following points are worth considering. In the Materials and Methods section, the authors have described that the study group consists of only tobacco chewers. However, in the first sentence of the second paragraph under Discussion, the authors have mentioned that the mean values of lipid profile were deranged in smokers and tobacco chewers. [1] This statement implies that smokers were also included in the study, and this contradicts the statements mentioned in the Materials and Methods and Results sections. It is not clear in the article whether the study groups comprised only strict tobacco chewers, the subjects chewing betel nut in addition to smoking, or a combination of tobacco chewers and smokers. It has been reported that people chewing tobacco alone are at a high risk of presenting acute myocardial infarction. [2] It should be noted that betel nut chewing with or without tobacco shows the risk of cardiovascular disease (CVD) when compared with nonusers. [3] Greater risk of CVD owing to tobacco in the chewing form is owing to prolonged absorption in greater quantities. [4] Betel nut chewing presents a higher risk of CVD than smoking. [3] Nicotine and arecoline present in tobacco and betel quid cause dyslipidemia and hypertension, resulting in CVD. [3]

Vagish Kumar, L. S.

Department of Oral Medicine and Radiology, Yenepoya Dental College and Hospital, Yenepoya Research Center, Yenepoya University, Mangalore, Karnataka, India.

Correspondence to: Vagish Kumar L S, E-mail: :

Received May 25, 2015. Accepted July 4, 2015

DOI: 10.5455/njppp.2015.5.2505201571


[1.] Ahmed QR, Gupta N, Goyal S, Ansari SJ. Comparative study on lipid profile in tobacco chewers and nontobacco chewers. Natl J Physiol Pharm Pharmacol. 2015;5(2):142-4.

[2.] Gupta R, Gupta N, Khedar RS. Smokeless tobacco and cardiovascular disease in low and middle income countries. Indian Heart J. 2013;65(4):369-77.

[3.] Zhang LN, Yang YM, Xu ZR, Gui QF, Hu QQ. Chewing substances with or without tobacco and risk of cardiovascular disease in Asia: a meta-analysis. J Zhejiang Univ Sci B. 2010;11(9):681-9.

[4.] Gupta BK, Kaushik A, Panwar RB, Chaddha VS, Nayak KC, Singh VB, et al. Cardiovascular risk factors in tobacco-chewers: a controlled study. J Assoc Physicians India. 2007;55:27-31.

Source of Support: Nil, Conflict of Interest: None declared.

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Article Details
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Author:Vagish, Kumar L.S.
Publication:National Journal of Physiology, Pharmacy and Pharmacology
Article Type:Letter to the editor
Date:Sep 1, 2015
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