Cigarette and Waterpipe Smoking are Associated with the Risk of Stroke in Lebanon

Cigarette and waterpipe (shisha and hookah) smoking are main public health concerns in Lebanon. We aim to assess the relationship between smoking and stroke, mainly waterpipe smoking, to better apply preventive and therapeutic interventions. A case-control study was conducted at five tertiary private and governmental hospitals in Lebanon between January 1st, 2015 and December 31st, 2016, using a standardized questionnaire. A stepwise ascending logistic regression was conducted. Odds ratio through 95% confidence interval (CI) expressed the degree of association among variables. In total, 650 patients were involved in the study with 205 stroke cases and 445 stroke-free normal individuals considered as controls. The risk of stroke was found to increase significantly among current cigarette smokers; total stroke Odds ratio (OR) = 2.79 (95% CI, 1.72-4.54), ischemic stroke OR = 2.59 (95% CI, 1.46-4.59), and hemorrhagic stroke OR = 4.25 (95% CI, 1.33-13.59). The risk of total and ischemic stroke was also found to increase significantly among current waterpipe smokers; OR 4.99 (95% CI, 2.07-11.99) and 6.25 (95% CI, 2.26-17.39), respectively. Moreover, waterpipe smoking was observed to have a stronger association with stroke in current cigarette smokers than non-smokers. Waterpipe smoking was found to be associated with stroke in this study. Moreover, this association is stronger among cigarette smokers, demonstrating a quantitative interaction between waterpipe and cigarette smoking.