{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:36:55Z","timestamp":1784853415182,"version":"3.55.0"},"reference-count":47,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health and Welfare","award":["MOHW 108-TDU-B-212-124016"],"award-info":[{"award-number":["MOHW 108-TDU-B-212-124016"]}]},{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Hospital","doi-asserted-by":"publisher","award":["KMU106011, KMUH105-5M07, KMUH106-6T02, and KMUH-S10605"],"award-info":[{"award-number":["KMU106011, KMUH105-5M07, KMUH106-6T02, and KMUH-S10605"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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\u20132018 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\u2013Kenny 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\u20137.84). 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.<\/jats:p>","DOI":"10.3390\/ijerph17207472","type":"journal-article","created":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T21:24:39Z","timestamp":1602710679000},"page":"7472","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Betel-Quid Chewing, Heart Failure, and Premature Ventricular Contractions in Patients with Cardiopulmonary Symptoms"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1872-4395","authenticated-orcid":false,"given":"Tien-Chi","family":"Huang","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan"},{"name":"Division of Cardiology, Ministry of Health and Welfare Hengchun Tourism Hospital, Pingtung 94641, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Tsung","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan"},{"name":"Division of Cardiology, Ministry of Health and Welfare Hengchun Tourism Hospital, Pingtung 94641, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-Chih","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ministry of Health and Welfare Hengchun Tourism Hospital, Pingtung 94641, Taiwan"},{"name":"Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2473-5824","authenticated-orcid":false,"given":"Frances M.","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy Education, Medical Center, Kansas University, KS 66045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1123-6954","authenticated-orcid":false,"given":"Wei-Chung","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan"},{"name":"School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0988-264X","authenticated-orcid":false,"given":"Chien-Hung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan"},{"name":"Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.drugalcdep.2017.06.039","article-title":"Intoxication and substance use disorder to Areca catechu nut containing betel quid: A review of epidemiological evidence, pharmacological basis and social factors influencing quitting strategies","volume":"179","author":"Osborne","year":"2017","journal-title":"Drug Alcohol Depend."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1080\/13556210120091464","article-title":"Metabolic effects of the consumption of Areca catechu","volume":"7","author":"Boucher","year":"2002","journal-title":"Addict. 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