E-Hookah Vaping May Trigger Inflammation and Blood Clotting Risk, Suggests Study
A small crossover trial published in the Journal of the American Heart Association has revealed that e-hookah vaping induces a proinflammatory and procoagulant state, regardless of whether it contains nicotine. These findings suggest that nicotine-free e-hookah is not risk-free and that vaping itself may increase inflammation and the tendency for blood clot formation, potentially raising cardiovascular risk. The study was conducted by Mary R. and colleagues.
For the isolation of the effects due to acute changes in the cardiovascular system due to nicotine as well as non-nicotine components in the e-liquid, sixteen habitual hookah smokers (19% female; average age 26±1 years) were enrolled from January 2020 to November 2022. The subjects underwent three different 30 minutes vaping sessions (nicotine containing, non-nicotine containing, and control session) separated by ≥ 7 days washout period in a randomized crossover fashion as per the CONSORT statement. The subjects vaped same flavored e-liquid (Simply Mango, 50/50 propylene glycol/vegetable glycerin) either 6 mg/mL or 0 mg/mL of nicotine concentration at 50 watts device power.
Key findings:
- Using an e-hookah containing nicotine results in an increase in plasma nicotine concentrations of 5.74 ng/mL (95% CI, 3.00–8.47; P < 0.001), while no increase was observed in the absence of nicotine.
- Nicotine vaping stimulates the heart rate by +8 bpm (95% CI, 1–14; P = 0.02) and the mean arterial pressure with an increase of 6 mmHg (95% CI, 2–10; P = 0.01), while no such changes were recorded during non-nicotine vaping.
- Nonnicotine e-hookah vaping also led to an acute increase of plasma fibrinogen concentrations of +12.50 mg/dL (95% CI, 3.05–21.95; P = 0.01).
- The nicotine-containing e-hookah increased the plasma fibrinogen levels by +9.20 mg/dL (95% CI, 3.33–15.07; P = 0.01).
- The paraoxonase-1 activity and the oxidant index of high-density lipoproteins did not change after any of the three types of exposures, and no adverse events were reported.
In summary, e-hookah vaping leads to increased levels of plasma fibrinogen regardless of whether there is any nicotine present. This observation indicates the pro-inflammatory and pro-coagulant effects that arise from e-hookah vaping. Contrary to popular belief, non-nicotine electronic hookah vaping does not serve as a healthier choice compared to the conventional smoking of tobacco
Reference:
Rezk‐Hanna, M., Gupta, R., Sakti, P., Cheng, C. W., Brecht, M. L., Benowitz, N. L., & Araujo, J. A. (2026). Acute Effects of Electronic Hookah Vaping With and Without Nicotine on Cardiovascular Disease–Related Biomarkers in Young Adults: A Randomized Trial. Journal of the American Heart Association. https://doi.org/10.1161/jaha.125.041217
