Waterpipe smoking is linked to higher cardiovascular mortality
Compared with never-smokers, ever-smokers of waterpipe had about a 60% higher risk of cardiovascular death, with a hazard ratio of 1.57.
American Journal of Preventive Cardiology
In a cohort of 35,646 Vietnamese adults aged 18 and older, ever-smoking waterpipe was associated with an increased risk of cardiovascular disease death. Researchers followed participants recruited between 2007 and 2019 for a median of 11.01 years, identifying 344 cardiovascular deaths. Compared with never-smokers, ever-smokers of waterpipes had a hazard ratio of 1.57 for cardiovascular death and 1.44 for death from cerebrovascular disease. Dual ever-smokers of waterpipes and cigarettes showed a hazard ratio of 1.77 for cardiovascular mortality. Furthermore, participants who smoked at least 11 pack-years of waterpipe and reported ever using alcohol had a hazard ratio of 2.19 for cardiovascular death compared with non-smokers who did not use alcohol.
Why it matters
Cardiovascular diseases are a primary contributor to age-related mortality worldwide. Identifying waterpipe smoking as an associated risk factor helps clarify how non-cigarette tobacco use relates to vascular health across adult lifespans.
Caveats
Because this study is observational, it cannot establish a direct causal relationship between waterpipe smoking and cardiovascular mortality. The findings reflect a single cohort recruited in Northern Vietnam, which may limit generalizability to other populations.
The paper
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Thinh Gia Nguyen, Dung Thuy Thi Truong, Phuoc Hong Le, Lang Wu, Yen Thi‐Hai Pham,Duy Tan University · Houston Methodist
American Journal of Preventive Cardiology · 28 Feb 2026