Hookah smoking tied to stroke, heart attack by causing blood clots: AHA Study

USA: Hookah smoking can cause the formation of blood clots that can increase the risk of stroke or heart attack, according to a recent study conducted in mice. 

According to the study, published in the AHA journal Arteriosclerosis, Thrombosis and Vascular Biology, tobacco smoke from a hookah/water pipes can cause the formation of blood clots within an average of about 11 seconds compared to an average of 5 minutes for clotting without hookah smoke exposure. 

Earlier, the tabletop pipes were considered to be 'healthier' than traditional cigarettes because the smoke goes through water before inhalation. The study, conducted for the first time in mice found that smoke from hookah causes blood to function abnormally.

"Our findings provide new evidence that hookah smoking is as unhealthy – if not more so – than traditional cigarettes," said Fadi Khasawneh, associate professor and chair of pharmaceutical sciences at The University of Texas at El Paso. "Smoking a hookah, cigarettes, e-cigarettes or other forms of tobacco all increase your risk for heart disease and stroke."

Fadi Khasawneh and colleagues used a waterpipe whole-body exposure protocol that mimics real-life human exposure scenarios and investigated its effects, relative to clean air, on platelet function, hemostasis, and thrombogenesis. 

"Hookah smoking, which is becoming more popular in Western countries, is perceived as less harmful than cigarettes, yet hookahs carry a toxic profile that is thought to be comparable or to even exceed that of traditional cigarettes. Some studies have found that the smoke emitted from one hookah tobacco smoking episode contains significantly more harmful chemicals compared to a single cigarette," said Khasawneh. 

In this study, researchers exposed mice to hookah smoke from a smoking machine that mimicked real-life smoking habits. The smoking machine used 12 grams of commercially available, flavored tobacco that included tobacco, glycerin, molasses and natural flavor with nicotine and tar. Researchers then compared platelet activity among the exposed vs. the unexposed mice.

Key findings include:

The study simulated the type of nicotine exposure that occurs with smoking a hookah, which the researchers verified by measuring the levels of cotinine, the nicotine metabolite.

In May 2019, the American Heart Association published a Scientific Statement, "Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk," to analyze available research on the health effects of hookah smoking. The Statement notes that hookah smoking results in inhaling significant levels of toxic chemicals such as carbon monoxide and particulates from tobacco that can harm blood vessels, the heart, and lungs, as well as creating a dependence on nicotine.

"This study provides additional evidence that, contrary to popular belief, hookah smoking adversely affects cardiovascular health. From 2011 to 2015, the number of United States-based waterpipe establishments is estimated to have more than doubled, and interest has grown among both teens and adults," said Aruni Bhatnagar, Ph.D., chair of the Scientific Statement writing group. "Although the tobacco industry has found novel ways to popularize and increase the use of new products, studies like this highlight the high risk of hookah smoking."

"Our findings demonstrate that WPS exposure directly modulates hemostasis and increases the risk of thrombosis and that this is mediated, in part, via a state of platelet hyperactivity. The negative health impact of WPS/hookah should not be underestimated. Moreover, this study should also help in raising public awareness of the toxic effects of waterpipe/hookah." concluded the authors. 

The study, "Short-Term Exposure to Waterpipe/Hookah Smoke Triggers a Hyperactive Platelet Activation State and Increases the Risk of Thrombogenesis," is published in the AHA journal Arteriosclerosis, Thrombosis and Vascular Biology.

DOI: 10.1161/ATVBAHA.119.313435