Cardiovascular effects of waterpipe smoking: a systematic review and meta-analysis

Abstract

Waterpipe smoking has developed into a major and rapidly growing global tobacco epidemic affecting more than 100 million people worldwide. This study identifies and analyzes comprehensively all available data on the cardiovascular effects of waterpipe smoking. Databases PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for studies published until December 2019 assessing cardiovascular effects of waterpipe smoking. We included experimental, cohort, cross-sectional and case-control studies and excluded systematic reviews, case reports/series and qualitative studies. Studies not conducted in humans or not distinguishing waterpipe smoking from other forms of smoking were also excluded. A total of 42 studies with 46 cardiovascular parameters were eligible for analysis. The meta-analysis included 31 studies with 38,037 individuals. Results showed that one waterpipe smoking session leads to immediate increases in heart rate and blood pressure (P < 0.001). Compared to non-smokers, waterpipe smokers had significantly lower high-density lipoprotein levels (P < 0.001), higher levels of low-density lipoprotein (P = 0.04), triglyceride (P < 0.001) and fasting blood glucose (P = 0.03) and higher heart rate (P = 0.04) with a tendency to have higher blood pressure. Mean heart rate, blood pressure and lipids levels did not differ between waterpipe and cigarette smokers, except for total cholesterol, being higher among waterpipe smokers (P < 0.001). Current level of evidence suggests that waterpipe smoking is associated with substantial adverse effects on cardiovascular system, which seem to be similar to those of cigarette smoking. Longitudinal studies are required to scrutinize the magnitude of these effects.

Increased expression of advanced glycation endproducts in the gingival crevicular fluid compromises periodontal status in cigarette-smokers and waterpipe users

“…Waterpipe users often perceive that this form of tobacco inhalation is less injurious to health compared with conventional cigarette-smoking [ 28 ]. Nevertheless, scientific evidence has also shown that the health-hazards of waterpipe-use are similar to those of cigarette-smoking [ 29 ]; and waterpipe-usage is “a global public health problem” [ 25 ]. Mokeem et al [ 30 ] reported that clinical and radiographic parameters of periodontal inflammation are poorer in cigarette-smokers and waterpipe-users than never-smokers with no statistically significant difference between the former groups (cigarette-smokers and waterpipe-users).…”

Prevalence of hookah smoking among Iranian pupils and university students: An updated systematic review and meta‐analysis

“…The risks of hookah smoking are often undermined due to various misconceptions, such as the use of flavouring agents in tobacco products and the false public opinion that hookah is healthy because the hazardous agents in the tobacco are filtered through the water inside the tank 3 . Nonetheless, hookah is similar to cigarettes in terms of causing diseases such as cancer, respiratory and gastrointestinal disorders, chronic pulmonary diseases and cardiovascular diseases 4,5 . Furthermore, the persistent use of hookah could lead to nicotine dependency 6,7 …”

“… 3 Nonetheless, hookah is similar to cigarettes in terms of causing diseases such as cancer, respiratory and gastrointestinal disorders, chronic pulmonary diseases and cardiovascular diseases. 4 , 5 Furthermore, the persistent use of hookah could lead to nicotine dependency. 6 , 7 …”

Adverse Effects of Cannabinoids and Tobacco Consumption on the Cardiovascular System: A Systematic Review

“…Besides traditional risk factors, tobacco smoking has been considered a significant cause of CVD [ 1 , 3 , 4 , 5 ]. Whether it is passive or active smoking, cigarettes, or other nicotine-delivery systems like waterpipes or non-smoke tobacco, they all share most of the harmful effects on the heart and blood vessels [ 3 , 4 , 6 ].…”

“…Besides traditional risk factors, tobacco smoking has been considered a significant cause of CVD [ 1 , 3 , 4 , 5 ]. Whether it is passive or active smoking, cigarettes, or other nicotine-delivery systems like waterpipes or non-smoke tobacco, they all share most of the harmful effects on the heart and blood vessels [ 3 , 4 , 6 ]. The mechanism by which tobacco consumption causes this massive damage is multifactorial, ranging from containing many chemicals that disrupt cellular function to the oxidative stress and inflammation of approximately every tissue type in the human body [ 3 , 4 ].…”