High Carbon Monoxide Levels from Charcoal Combustion Mask Acute Endothelial Dysfunction Induced by Hookah (Waterpipe) Smoking in Young Adults

BACKGROUND:Hookah smoking is marketed to youth as a harmless alternative to cigarettes. Although cigarette smoking acutely impairs endothelial function, the effect of smoking fruit-flavored hookah tobacco is unknown. Because charcoal traditionally is used to heat the hookah tobacco in the waterpipe,...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2019-05, Vol.139 (19), p.2215-2224
Main Authors: Rezk-Hanna, Mary, Mosenifar, Zab, Benowitz, Neal L, Rader, Florian, Rashid, Mohamad, Davoren, Katherine, Moy, Norma B, Doering, Lynn, Robbins, Wendie, Sarna, Linda, Li, Ning, Chang, L Cindy, Elashoff, Robert M, Victor, Ronald G
Format: Article
Language:English
Subjects:
Adolescent
Adult
Angioplasty, Balloon
Brachial Artery - physiology
Carbon Monoxide
Charcoal
Endothelium, Vascular - pathology
Female
Heating
Humans
Male
Nicotine - blood
Regional Blood Flow
Water Pipe Smoking - adverse effects
Young Adult
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Summary:BACKGROUND:Hookah smoking is marketed to youth as a harmless alternative to cigarettes. Although cigarette smoking acutely impairs endothelial function, the effect of smoking fruit-flavored hookah tobacco is unknown. Because charcoal traditionally is used to heat the hookah tobacco in the waterpipe, hookah smoke delivers tobacco toxicants and nicotine plus charcoal combustion productsnot only carbon-rich nanoparticles, oxidants that may destroy nitric oxide and impair endothelial function, but also large amounts of carbon monoxide (CO), a putative vasodilator molecule. METHODS:To test the acute effect of hookah smoking on endothelial function, in young adult hookah smokers (n=30, age 26±1 years, mean±SE), we measured plasma nicotine, exhaled CO, and brachial artery flow-mediated dilation (FMD) before and after charcoal-heated hookah smoking. To remove the effect of charcoal combustion, the same measurements were performed when the same flavored hookah tobacco product was heated electrically (n=20). As a positive internal control, we studied age-matched cigarette smokers (n=15) who smoked 1 cigarette. To isolate the effect of the CO boost on FMD, hookah smokers (n=8) inhaled a 0.1% CO gas mixture to approximate their CO boost achieved with charcoal-heated hookah smoking. RESULTS:Nicotine levels increased similarly with all types of smoking, whereas exhaled CO increased 9- to 10-fold more after charcoal-heated hookah than after either electrically heated hookah or cigarette smoking. FMD did not decrease after smoking charcoal-heated hookah but instead increased by +43±7% (P
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.118.037375