title: Smoking water-pipe, chewing nass and prevalence of heart disease: a cross-sectional analysis of baseline data from the Golestan Cohort Study, Iran.
abstract: 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.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Baseline data (collected in 2004-2008) from a prospective population-based study in Golestan Province, Iran.
  
  
  METHODS
  50 045 residents of Golestan (40-75 years old; 42.4% men).
  
  
  METHODS
  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.
authors.affiliation: One Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: Farhad
authors.initials: F
authors.lastname: Islami
authors.forename: Akram
authors.initials: A
authors.lastname: Pourshams
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vedanthan
authors.forename: Hossein
authors.initials: H
authors.lastname: Poustchi
authors.forename: Farin
authors.initials: F
authors.lastname: Kamangar
authors.forename: Asieh
authors.initials: A
authors.lastname: Golozar
authors.forename: Arash
authors.initials: A
authors.lastname: Etemadi
authors.forename: Hooman
authors.initials: H
authors.lastname: Khademi
authors.forename: Neal D
authors.initials: ND
authors.lastname: Freedman
authors.forename: Shahin
authors.initials: S
authors.lastname: Merat
authors.forename: Vaani
authors.initials: V
authors.lastname: Garg
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.forename: Jon
authors.initials: J
authors.lastname: Wakefield
authors.forename: Sanford M
authors.initials: SM
authors.lastname: Dawsey
authors.forename: Paul
authors.initials: P
authors.lastname: Pharoah
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Christian C
authors.initials: CC
authors.lastname: Abnet
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008409:Mastication; D008875:Middle Aged; D010936:Plant Extracts / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D014030:Tobacco, Smokeless / Q000009:adverse effects*
chemical_list: D010936:Plant Extracts; C015378:nas