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(19) Although Doppler studies showed intracranial cerebral hemodynamics is not affected during betel chewing, inotropic and chronotropic effect to the heart from betel chewing is probably an unfavorable risk for patients with ischemic heart disease

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While they may not hit as intensely upfront as with cigarettes, the fatigue and cravings can linger for weeks

Emerging evidence suggests that tobacco use may accelerate this progression through multiple pathways, though most data relate to smoked tobacco