GP Clinics


AHA: Hookah Smoking Raises the Risk for CVD

Tobacco smoking with a water pipe can have harmful health effects, including an increased risk for coronary artery stenosis, pulmonary disease, and cardiovascular disease. As the practice becomes more common—especially among youth and young adults—the American Heart Association has released a scientific statement outlining the cardiovascular effects that both short- and long-term hookah use can have. 
In young, healthy individuals, smoking tobacco via a water pipe for 15 to 30 minutes increases the heart rate by 6 to 13 beats per minute, systolic blood pressure by 3 to 16 mm Hg, and diastolic blood pressure by 2 to 14 mm Hg. 
Other short-term effects include:
A decrease in heart rate variability,
A modest increase in coronary blood flow,
An increase in myocardial oxygen demand, and
Changes in cardiac and vascular function and blood flow.
“Overall, the short-term cardiovascular effects are consistent with the sympathomimetic effects of nicotine,” the statement’s authors wrote.
Among individuals whose lifetime exposure to hookah is more than 40 water-pipe-years, the risk for being angiographically diagnosed with coronary artery stenosis triples. In fact, there is a significantly higher prevalence of coronary disease among those who smoke water pipes than among those who smoke cigarette or who do not smoke.
Compared with individuals who smoke cigarettes, those who smoke water pipes are more likely to have worse in-hospital outcomes, including higher mortality, as well as more frequent myocardial ischemia and higher recurrent myocardial infarction rates.
Smoking tobacco with a water pipe also increases the risk for cigarette smoking initiation compared with the risk among those who have never smoked. 
“Certain behavioral strategies have proved effective for cigarette cessation may be useful when adapted for water pipe cessation,” the authors wrote. “These techniques include educating the smoker about the health consequences of water pipe use, increasing motivation to quit by reviewing the pros and cons of smoking and quitting, setting and preparing for the quit day, and providing coping assistance to prevent relapse.”

Bhatnagar A, Maziak W, Eissenberg T, et al. Water pipe (hookah) smoking and cardiovascular disease risk: a scientific statement from the American Heart Association. Circulation. 2019;139(19):e917-e936. 10.1161/CIR. 0000000000000671.