Hookah Smoking: A Potentially Risk Factor for First-Ever Ischemic Stroke

Objective: Hookah consumption, as a common non-cigarette tobacco product, is wrongly considered as less harmful. Moreover, little is known about hookah consumption and risk of ischemic stroke. The current study aimed to assess the association between hookah consumption and first-ever ischemic stroke (FEIS). Methods: This case-control study was performed on individuals admitted at a tertiary referral center in Shiraz, Southern Iran between October 1, 2018 and September 20, 2019. We compared FEIS patients with randomly selected stroke-free individuals as a control group. Using a multiple logistic regression analysis, we assessed the association between hookah consumption and FEIS. Results: A total of 208 FEIS patients (mean age 65.2 +/- 15.9 years) and 212 age and sex-matched controls (mean age 63.2 +/- 14.4) were recruited. The prevalence of vascular risk factors and comorbidities including ischemic heart disease, hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, cigarette smoking, and sleep apnea was higher in patients with FEIS than their control counterparts. After adjusting for a wide range of confounders, including socioeconomic factors, hookah consumption was still an independent risk factor for FEIS (odds ratio: 3.2, 95% CI: 1.7-6.1). Conclusion: Hookah consumption is associated strongly with FEIS. Public awareness about risk of hookah consumption should be raised. (c) 2020 Elsevier Inc. All rights reserved.