Heart Researchers Warn Smokers of the Hidden, Dangerous Effects of Hookah

Just because it's fruity and sweet doesn't mean it's innocuous.

While cigarette smoking is still a leading cause of preventable death, the last 50 years have witnessed tremendous strides in curbing the disease-causing practice. But in a scientific statement released Friday, researchers with the American Heart Association warn that we need to put same level of effort into preventing other forms of tobacco use — namely, hookah. In the journal Circulation, they warn that hookah, an increasingly popular pastime with ancient origins, impacts heart rate and blood pressure, potentially putting it on par with cigarette smoking when it comes to ill health effects.

Hookah is a form of tobacco consumption sometimes referred to as “water-pipe” tobacco because the smoke is bubbled through liquid before being inhaled. It’s traditionally used by older crowds in the rural areas of South Asian and Mediterranean countries, but more recently, hookah bars and lounges have spread throughout metropolitan areas around the world.

According to the CDC hookah use by youth and college students is especially increasing. An estimated one percent of American adults smoked hookah in 2017 — double the number seen several years before.  

A hookah bar.

Wikimedia Commons

One of the issues with hookah is that scientists know it causes damage, but they don’t know the extent of that damage. “Future studies that focus on the long-term adverse health effects of intermittent water-pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use,” the researchers write.

Here’s what they do know: A single session of hookah results in greater exposure to carbon monoxide than a single cigarette, and in turn the smoke contains other potentially harmful chemicals that affect the cardiovascular system. There’s also evidence that hookah affects heart rate, blood pressure regulation, tissue oxygenation, and vascular function, and long-term use is linked to an increased risk coronary artery disease.

What’s most concerning to the authors is the pervasive idea that hookah is less harmful than other forms of smoking, which could be increasing its appeal. The tobacco sold for hookah users doesn’t come with a health warning and flavors, and sweeteners are added to the tobacco to mask its harshness. The American Heart Association strongly recommends avoiding tobacco in any form — even when it is presented in a social atmosphere that seems innocuous.

“Many young people mistakenly believe that smoking tobacco from a hookah is less harmful than cigarette smoking because the tobacco is filtered through water, but there is no scientific evidence that supports that claim,” Aruni Bhatnagar, Ph.D., chair of the writing group for the statement and a professor of medicine at the University of Louisville, said. “However, there is evidence to suggest that hookah smoking is addictive and can lead to the use of other tobacco products such as cigarettes.”

Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.
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