Tobacco smoking using a hookah (waterpipe) is rapidly increasing in popularity worldwide, particularly among youth. The spread of hookah smoking is promoted by the unsubstantiated belief that smoke is detoxified as it passes through the water filled basin; heavy marketing and glamorization of fruit-flavored tobacco products; and lack of policy regulation. Because traditional hookah is the only form of tobacco product that uses burning charcoal briquettes to heat the tobacco, in addition to tobacco combustion products, smokers are exposed to charcoal combustion products including high levels of carbon monoxide (CO), a potent vasodilator molecule, shown to mask acute hookah-induced endothelial dysfunction. Long-term cigarette smoking is known to cause impairment in endothelial and vascular function, and while both cigarette and hookah are vehicles for tobacco, the comparative effect of long-term hookah smoking is unknown. Accordingly, we now turn our attention to elucidate the long-term health effect of hookah smoking on endothelial and vascular function; and identify biomarkers of harm by which chronic hookah smoking affects vascular health. We hypothesize that with long- term hookah smoking, tobacco combustion products?mainly nicotine, high concentrations of particles, oxidants?and flavorings predominate and override the vasodilator effects of CO, leading to persistent endothelial and vascular dysfunction, thereby increasing the risk of future atherosclerosis and cardiovascular disease. We further hypothesize that the hookah-induced vascular dysfunction is at least in part mediated by enhanced formation of oxygen-derived free radicals, promoting systemic vascular inflammation and oxidative stress. To accomplish our goals, in 34 healthy chronic hookah smokers 21-49 years of age who do not smoke cigarettes?matched for age and sex with 34 cigarette smokers and 34 non-smokers?we will measure: (a) endothelial function, by brachial artery flow-mediated dilation; and (b) vascular stiffness, by carotid-femoral pulse wave velocity and aortic augmentation index, as a measure of wave reflection. Biological markers of inflammation (high sensitivity C-reactive protein, 8-iso-prostaglandin F2?, fibrinogen) and oxidative stress (prooxidant high- density lipoprotein oxidant index and total antioxidant capacity) will be collected. Because hookah smoking has outpaced research needed to propose evidence-based regulation, findings will: (a) fill in large gaps in our understanding of the chronic effects of hookah smoking; and (b) provide a foundation for future long-term studies to establish the relationship between physiological and systemic biomarkers to specific cardiovascular pathologic processes, thereby building a scientific basis to inform the currently debated national policy decisions specific to hookah.
Tobacco smoking using a hookah (waterpipe) is increasing in popularity worldwide, particularly among youth who endorse marketing claims that fruit-flavored hookah smoke is detoxified as it passes through the water filler basin, but emerging studies do not support this mythology. This project will examine the chronic cardiovascular effects of hookah smoking and identify biomarkers of harm by which long-term hookah smoking affects vascular health. Results from this study have the potential to fill in large gaps in our understanding of the long-term vascular effects of hookah smoking and may be useful in building a scientific basis needed to inform the currently debated national policy decisions specific to hookah.
