Waterpipe Use and Its Cardiovascular Effects: A Systematic Review and Meta-Analysis of Case-Control, Cross-Sectional, and Non-Randomized Studies

Abstract

Approximately 100 million people globally smoke cigarettes, making it a significant and quickly spreading global tobacco epidemic. Substance use disorders are frequently evaluated by non-randomized studies. Tobacco use and its impacts on the cardiovascular system were the subjects of a comprehensive search across five electronic databases: Cochrane, MEDLINE, Scopus, Embase, and PubMed. The findings demonstrated that waterpipe smokers in comparison to non-smokers have immediate elevations in heart rate and blood pressure, lower levels of high-density lipoprotein, higher levels of low-density lipoprotein, higher levels of triglycerides, higher levels of fasting blood glucose, and a higher heart rate. Users of waterpipes and cigarettes had similar average heart rates, blood pressure, and lipid levels, with the exception that waterpipe smokers had greater total cholesterol. Smoking a waterpipe has significant negative effects on the cardiovascular system comparable to cigarette smoking, and non-randomized studies proved to yield substantial evidence related to its cardiovascular effects. Such study designs can be used to evaluate substance use and its cardiovascular impact.

Keywords: cardiovascular disease; heated tobacco products; non-randomized studies; tobacco use disorder; waterpipe.

Figure 1. The search procedure depicted in the PRISMA flowchart was used to locate the 16 studies.

PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; MEDLINE, Medical Literature Analysis and Retrieval System Online; EMBASE, Excerpta Medica Database

Figure 2. Risk-of-bias assessment, with green, yellow, orange, and white indicating low, moderate, serious, and critical risks, respectively.

[20,27-41]

Figure 3. Plot demonstrating the acute effect of WPS.

WPS, waterpipe smoking; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure [20,27-30,37]

Figure 4. Forest plot showing a comparison of WPS and NS.

WPS, waterpipe smoking; NS, non-smoking [29,30,32-34,39,41]

Figure 5. Forest plots showing individual and pooled mean differences in cholesterol blood values in WPS when compared to NS.

WPS, waterpipe smoking; NS, non-smoking; TC, total cholesterol; LDL, low-density lipoprotein; HDL, high-density lipoprotein; TG, triglycerides [32-34,38,40]

Figure 6. A forest plot demonstrating HDL, LDL, TC, and TG pooled mean differences in WPS versus CS.

WPS, waterpipe smoking; CS, cigarette smoking; TC, total cholesterol; LDL, low-density lipoprotein; HDL, high-density lipoprotein; TG, triglycerides [34,38,40]

Figure 7. A plot showing a comparison of WPS and CS.

WPS, waterpipe smoking; CS, cigarette smoking; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure [20,34,39,41]