Graphical abstract
Graphical abstractFrom American Journal of Preventive Cardiology
Humans

Waterpipe smoking links to higher cardiovascular mortality

Ever-smokers of waterpipes had a higher risk of cardiovascular death (HR 1.57) compared with never-smokers across an 11-year median follow-up.

American Journal of Preventive Cardiology

In a prospective cohort of 35,646 Vietnamese adults aged 18 and older, researchers examined how ever-smoking waterpipe tobacco affects cardiovascular disease mortality. Participants were recruited between 2007 and 2019 for the Hanoi Prospective Cohort Study and followed for a median of 11.01 years. Over this period, the authors identified 344 cardiovascular deaths. Compared with never-smokers, waterpipe smokers showed a higher risk of cardiovascular death (HR=1.57) and cerebrovascular death (HR=1.44). Dual smokers of both waterpipes and cigarettes experienced the greatest risk of cardiovascular death (HR=1.77). Furthermore, waterpipe smokers with at least 11 pack-years who also drank alcohol faced more than double the risk of cardiovascular mortality (HR=2.19) compared with non-smokers who did not consume alcohol.

Why it matters

Cardiovascular diseases represent a primary driver of age-related mortality and vascular deterioration worldwide. Demonstrating that waterpipe smoking substantially contributes to fatal vascular outcomes highlights an under-recognized environmental driver of vascular aging.

Caveats

The study is observational and restricted to a cohort from Northern Vietnam, meaning findings may not fully generalize to other populations or smoking patterns.

The paper

Waterpipe smoking and risk of cardiovascular disease mortality: Findings from a Prospective Cohort Study

Le NT, Nguyen HL, Le LT et al.

American Journal of Preventive Cardiology · 28 Feb 2026

doi.org/10.1016/j.ajpc.2026.101516 PubMed

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