Heart doi:10.1136/heartjnl-2012-302861
  • Epidemiology
  • Original article

Smoking water-pipe, chewing nass and prevalence of heart disease: a cross-sectional analysis of baseline data from the Golestan Cohort Study, Iran

  1. Paolo Boffetta2,10
  1. 1Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2Mount Sinai School of Medicine, The Tisch Cancer Institute and Institute for Transitional Epidemiology, New York, USA
  3. 3Mount Sinai School of Medicine, The Zena and Michael A. Wiener Cardiovascular Institute, New York, USA
  4. 4Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA
  5. 5Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
  6. 6International Agency for Research on Cancer, Lyon, France
  7. 7Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
  8. 8Departments of Biostatistics and Statistics, University of Washington, Seattle, Washington, USA
  9. 9Departments of Oncology and Public Health and Primary Care, University of Cambridge, Cambridge, UK
  10. 10International Prevention Research Institute, Lyon, France
  1. Correspondence to Professor Paolo Boffetta Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1079, New York, NY 10029, USA; paolo.boffetta{at}; Professor Reza Malekzadeh, Digestive Disease Research Center, Tehran University of Medical Sciences, Shariati Hospital, Kargar Shomali Avenue, Tehran 14117, Iran; malek{at}
  • Received 8 August 2012
  • Revised 31 October 2012
  • Accepted 6 November 2012
  • Published Online First 20 December 2012


Objective Water-pipe and smokeless tobacco use have been associated with several adverse health outcomes. However, little information is available on the association between water-pipe use and heart disease (HD). Therefore, we investigated the association of smoking water-pipe and chewing nass (a mixture of tobacco, lime and ash) with prevalent HD.

Design Cross-sectional study.

Setting Baseline data (collected in 2004–2008) from a prospective population-based study in Golestan Province, Iran.

Participants 50 045 residents of Golestan (40–75 years old; 42.4% men).

Main outcome measures ORs and 95% CIs from multivariate logistic regression models for the association of water-pipe and nass use with HD prevalence.

Results A total of 3051 (6.1%) participants reported a history of HD, and 525 (1.1%) and 3726 (7.5%) reported ever water-pipe or nass use, respectively. Heavy water-pipe smoking was significantly associated with HD prevalence (highest level of cumulative use vs never use, OR=3.75; 95% CI 1.52 to 9.22; p for trend=0.04). This association persisted when using different cut-off points, when restricting HD to those taking nitrate compound medications, and among never cigarette smokers. There was no significant association between nass use and HD prevalence (highest category of use vs never use, OR=0.91; 95% CI 0.69 to 1.20).

Conclusions Our study suggests a significant association between HD and heavy water-pipe smoking. Although the existing evidence suggesting similar biological consequences of water-pipe and cigarette smoking make this association plausible, results of our study were based on a modest number of water-pipe users and need to be replicated in further studies.

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