Iqbal Mohammad Perwaiz, Yakub Mohsin
Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
PLoS One. 2013 Dec 23;8(12):e83826. doi: 10.1371/journal.pone.0083826. eCollection 2013.
Smokeless tobacco (ST) use is highly prevalent in the South Asian populations. While there have been a number of reports on association of ST consumption with cancer, very few studies have been conducted to investigate its relationship with cardiovascular disease. Hyperhomocysteinemia is a well-recognized risk factor for cardiovascular disease; however, its association with ST use has never been investigated. The objective of this study was to evaluate the relationship of ST use with hyperhomocysteinemia in an urban Pakistani population.
METHODOLOGY/PRINCIPAL FINDINGS: In a cross-sectional study for assessment of risks of hyperhomocysteinemia, 872 healthy adults (355 males and 517 females of age range 18-60 years) were recruited from a low-income population in Karachi, Pakistan. A detailed questionnaire was administered which included information about smoking, non-smoking, use of ST alone (chewing as well as sniffing) and use of ST with betel nuts. Fasting serum/plasma levels of homocysteine, folate, vitamin B12 and pyridoxal phosphate (PLP; a coenzymic form of vitamin B6) were analyzed. In this population, 43.4% males and 15.5% females were found to be regular users of ST products. Laborers and vendors were the major ST consumers. Smoking was not found to be associated with plasma/serum concentrations of homocysteine, folate, vitamin B12 and PLP. However, homocysteine concentrations in the group which consumed ST alone and the group which consumed ST along with betel nut were significantly higher compared to the non-user group (17.7±7.5 µmol/L, 25.48 µmol/L vs. 11.95 µmol/L, respectively; p<0.01). Odds ratio for the association of hyperhomocysteinemia (>15 µmol/L) was 11-fold higher in the ST-consumer group compared to the non-user group, [OR (95%CI) = 11.34 (7.58-16.96); p<0.001], when the model was adjusted for age, gender, folate and vitamin B12 status.
This study shows a positive association between ST consumption and hyperhomocysteinemia in a low-income urban Pakistani population.
无烟烟草（ST）在南亚人群中使用极为普遍。虽然已有许多关于ST消费与癌症关联的报告，但很少有研究调查其与心血管疾病的关系。高同型半胱氨酸血症是心血管疾病一个公认的危险因素；然而，其与ST使用的关联从未被研究过。本研究的目的是评估巴基斯坦城市人群中ST使用与高同型半胱氨酸血症的关系。
方法/主要发现：在一项评估高同型半胱氨酸血症风险的横断面研究中，从巴基斯坦卡拉奇的低收入人群中招募了872名健康成年人（355名男性和517名女性，年龄在18 - 60岁之间）。发放了一份详细问卷，其中包括关于吸烟、不吸烟、单独使用ST（咀嚼和嗅吸）以及ST与槟榔一起使用的信息。分析了空腹血清/血浆中的同型半胱氨酸、叶酸、维生素B12和磷酸吡哆醛（PLP；维生素B6的辅酶形式）水平。在该人群中，发现43.4%的男性和15.5%的女性是ST产品的经常使用者。劳动者和小贩是主要的ST消费者。未发现吸烟与血浆/血清中的同型半胱氨酸、叶酸、维生素B12和PLP浓度有关。然而，单独使用ST的组和ST与槟榔一起使用的组中的同型半胱氨酸浓度显著高于非使用者组（分别为17.7±7.5 μmol/L、25.48 μmol/L对11.95 μmol/L；p<0.01）。当模型根据年龄、性别、叶酸和维生素B12状态进行调整后，ST消费者组中高同型半胱氨酸血症（>15 μmol/L）的关联优势比是非使用者组的11倍，[OR（95%CI）=11.34（7.58 - 16.96）；p<0.001]。
本研究表明在巴基斯坦城市低收入人群中，ST消费与高同型半胱氨酸血症之间存在正相关。
