Top Things to Know: Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk

Published: March 08, 2019
  1. Water pipe or hookah tobacco smoking is prevalent worldwide, especially among youth (12-17 years) and young adults (18-24 years) - 4.8% of high schoolers and 13.6% of young adults in the US; 9-15% among 13-15-year-olds (Global Youth Tobacco Survey).
  2. The spread of water pipe tobacco smoking is promoted by several factors, including sweetened and flavored water pipe tobacco, social media that promotes this method of tobacco use, and misperceptions regarding its addictive potential and adverse health effects.
  3. A majority of users believe that water pipe tobacco smoking is less harmful than cigarette smoking, that the probability of addiction is low, and that quitting water pipe tobacco smoking is not difficult.
  4. The risk of initiation of cigarette smoking may be higher (67%) among water pipe smokers than among those who have never smoked.
  5. The level of nicotine to which water pipe tobacco smokers are exposed has been demonstrated to be physiologically active in the short-term and can produce dependence with repeated exposure.
  6. While direct comparisons have some limitations, in comparison with a single cigarette, a single session of water pipe smoking typically results in greater exposure to carbon monoxide (CO). The CO levels to which water pipe users are exposed can produce toxicity with short-term exposure at high levels and interfere with exercise capacity.
  7. The smoking behavior associated with water pipe tobacco smoking – sessions lasting 30 minutes or more and involving the inhalation of many liters of smoke – can result in water pipe smokers inhaling substantial quantities of toxicants during a single use.
  8. Water pipe smoke contains high levels of particulate matter, which contains smaller particles at higher concentrations than cigarettes; meaning when comparing a single cigarette with a single water pipe session, water pipe use exposes smokers to significantly higher levels of heavier and more toxic polycyclic aromatic hydrocarbons (PAHs) than cigarettes, and cardiorespiratory toxicants such as Volatile Organic Compounds (VOCs), and heavy metals such as cadmium and lead that can injure the blood vessels and the brain.
  9. Although evidence of water pipe-attributable disease is not as robust as the evidence for cigarette smoking, growing evidence suggests that water pipe tobacco smoking is a risk factor for pulmonary and cardiovascular disease, with health effects impacting sympathetic activation, vascular dysfunction, systemic inflammation and oxidative stress, insulin resistance, enhanced coagulation and thrombosis, and lipid peroxidation; and leads to an acute and transient increase in heart rate and systolic blood pressure.
  10. As with exposure to cigarette smoking, individuals exposed to secondhand water pipe tobacco smoke and residual matter from water pipe use (i.e., third hand smoke) are at risk for negative health outcomes including wheezing, coughing, and respiratory issues.
  11. Heath care providers are encouraged to:
  • Ask users about water pipe use and frequency explicitly, using a variety of terms if necessary, as well as use of other tobacco products, as part of routine clinical examinations,
  • Advise users to quit water pipe and other tobacco product usage,
  • Assist water pipe smokers to quit by providing cessation counseling, including setting a quit date and providing social support and coping assistance, especially to prevent relapse,
  • Refer water pipe smokers to credible sources, including for information regarding potential addictiveness and health consequences of water pipe use, including this statement.

View the summary for Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk

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Citation

Bhatnagar A, Maziak W, Eissenberg T, Ward KD, Thurston G, King BA, Sutfin EL, Cobb CO, Griffiths M, Goldstein LB, Rezk-Hanna M; on behalf of the American Heart Association Behavioral Change for Improving Health Factors Committee of the Council on Lifestyle and Cardiometabolic Health and Council on Epidemiology and Prevention; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Stroke Council. Water pipe (hookah) smoking and cardiovascular disease risk: a scientific statement from the American Heart Association [published online ahead of print March 8, 2019]. Circulation. doi: 10.1161/CIR.0000000000000671.

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