Environmental Science and Pollution Research

, Volume 26, Issue 8, pp 8194–8201 | Cite as

Previous, current, and cumulative dose effect of waterpipe smoking on LDL and total cholesterol

  • Souheil HallitEmail author
  • Rabih Hallit
  • Chadia Haddad
  • Lara Youssef
  • Marouan Zoghbi
  • Rachelle Costantine
  • Nelly Kheir
  • Pascale Salameh
Research Article


The popularity of waterpipe smoking is dramatically increasing in Lebanon, reaching 36.9%, the highest among countries in the region. To the best of our knowledge, no studies have assessed the impact of waterpipe smoking on lipid levels in the Lebanese population. Therefore, the objective of the study was to evaluate the correlation between waterpipe smoking and LDL-C and total cholesterol levels in exclusive Lebanese waterpipe smokers compared to non-smokers. This cross-sectional study was conducted between October 2016 and February 2017, enrolling 308 patients (156 non-smokers and 147 waterpipe smokers) from four laboratories. Current and previous WS (beta = 66.64 and beta = 71.49) were significantly associated with higher LDL scores. Current WS was significantly associated with and total cholesterol levels (beta = 34.12). Cumulative WS (number of waterpipes per week × duration in years) was significantly associated with higher LDL-C and total cholesterol levels respectively (p < 0.001 for all 3 variables). The university level of education (beta = 8.89) and current alcohol drinking (beta = 8.81) were significantly associated with higher LDL scores. Our study demonstrated an association between previous or current waterpipe smoking and lipid level. Future research are needed to detect the direct cause of the relation between waterpipe smoking and CVD. Concerned authorities should set up awareness campaigns to increase alertness on dangers of WS and dependence, and encourage these young adults to embrace health-promoting behaviors.


Waterpipe LDL-C Total cholesterol Lebanon 



Low-density lipoproteins


Low-density lipoproteins cholesterol




Carbon oxide


Beirut Distress Scale 22


Food frequency questionnaire


High-density lipoproteins


Compliance with ethical standards

The Lebanese University Review Board has approved the study protocol based on the fact that it protects patients’ anonymity and confidentiality. A written informed consent was signed by those who approved to participate in the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Medicine and Medical SciencesHoly Spirit University of Kaslik (USEK)JouniehLebanon
  2. 2.INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - LibanBeirutLebanon
  3. 3.Research DepartmentPsychiatric Hospital of the CrossJal EddibLebanon
  4. 4.Department of Nursing and Health SciencesNotre-Dame UniversityShoufLebanon
  5. 5.Faculty of MedicineSaint-Joseph UniversityBeirutLebanon
  6. 6.Department of Agronomic SciencesHoly Spirit UniversityKaslikLebanon
  7. 7.Faculty of PedagogyUniversité de la Sainte FamilleBatrounLebanon
  8. 8.Faculty of PharmacyLebanese UniversityBeirutLebanon
  9. 9.Faculty of MedicineLebanese UniversityBeirutLebanon

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