Betel nut chewing and acute myocardial infarction: evidence from two cardiac care hospitals in Papua New Guinea

Introduction Betel nut (Areca catechu) chewing is a culturally embedded practice in Papua New Guinea (PNG). While its chronic health effects are documented, its role as a trigger for acute myocardial infarction (AMI) remains poorly understood. Methods We conducted a cross-sectional study (January 2020 to December 2021) at Port Moresby General Hospital and Alotau Provincial Hospital. Adult patients with confirmed AMI were assessed for betel nut use within one hour of symptom onset. Demographic, clinical, and biochemical data were collected. Multivariate adjustment was limited by small sample sizes, and crude associations are presented. Results Of 111 AMI patients, 40 (36%) reported chewing betel nut immediately prior to symptom onset. Betel nut-associated AMI (BIAMI) patients were significantly younger (mean age 46.5 vs. 57.3 years, P < 0.001), predominantly male, and more likely to have hypertension, diabetes, dyslipidaemia, and smoking history. Clinical measurements showed higher mean blood pressure (145/90 vs. 124/77 mmHg) and slightly elevated glucose in chewers. Electrocardiographic analysis revealed a predominance of anterolateral ST-segment elevation myocardial infarction (STEMI) in BIAMI patients (60% vs. 40%), whereas controls exhibited more diverse STEMI subtypes. Survival was higher among BIAMI patients (92.5% vs. 85.9%), with fewer heart failure complications and lower mortality (7.5% vs. 14.1%). Conclusion Betel nut chewing is a potential acute cardiovascular trigger in PNG. Incorporating betel nut history into cardiac assessments and culturally tailored public health messaging may improve prevention. Future research should employ prospective designs with biochemical exposure quantification to confirm causality.