Waterpipe Smoking and Risk of Cardiovascular Disease Mortality: Findings from a Prospective Cohort Study

Little is known about the role of waterpipe smoking and cardiovascular (CVD) risk. We evaluated the association between ever-smoking waterpipe and risk of death from incident CVD using data from the Hanoi Prospective Cohort Study, a prospective cohort study in Northen Vietnam. The current analysis included 35,646 Vietnamese aged 18 years and older who were recruited during 2007-2019 period. Cox proportional hazard regression model was used to calculate the hazard ratio (HR) and 95% confidence intervals (95% CIs) for risk of CVD mortality related to ever-smoking waterpipe. After a median follow-up of 11.01 years (range: 0.13-11.64 years), we identified 344 CVD deaths. Overall, compared with never-smokers, ever-WTP smokers were about 60% higher risk of CVD deaths (HR=1.57; 95% CI: 1.16-2.13), 44% higher risk of deaths from cerebrovascular disease (HR=1.44; 95% CI: 1.08-1.93) and the highest of CVD deaths was among dual ever-smokers of waterpipe and cigarette (HR=1.77, 95% CI: 1.21-2.60). Also, compared with non-smokers & no alcohol user, the CVD risk was the highest among WTP smokers who smoked ≥11 pack-years (i.e., 1 pack/day x11 years) & ever-alcohol drinkers (HR=2.19, 95% CI: 1.42-3.38). In a large prospective cohort study, we showed that ever-waterpipe smoking was associated with increased risk of CVD deaths, particularly deaths from cerebrovascular disease; and higher among dual smokers of cigarettes and waterpipe. Additionally, smoking cigarette and drinking alcohol doubled risk of CVD death. These findings suggest that waterpipe smoking should receive equal attention as cigarette smoking in tobacco control and prevention programs.