Smidt Heart Institute (M.R.-H., F.R., M.R., K.D., N.B.M., R.G.V.), Cedars-Sinai Medical Center, Los Angeles, CA.
School of Nursing (M.R.-H., L.D., W.R., L.S.), University of California, Los Angeles.
Circulation. 2019 May 7;139(19):2215-2224. doi: 10.1161/CIRCULATIONAHA.118.037375.
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 products: not 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.
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.
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<0.001). In contrast, FMD decreased by -27±4% ( P<0.001) after smoking electrically heated hookah, comparable to the decrease after cigarette smoking. FMD increased markedly by 138±71% ( P<0.001) after breathing CO gas, 2.8 times more than the increase induced in the same subjects after smoking charcoal-heated hookah ( P<0.001), despite comparable increases in exhaled CO (24±1 versus 28±3 ppm, hookah versus CO).
Smoking hookah tobacco, similar to cigarette tobacco, acutely impairs endothelial function. With traditional charcoal-heated hookah smoking, the acute endothelial dysfunction is masked by high levels of carbon monoxide, a potent vasodilator molecule generated by charcoal combustion. With respect to large-artery endothelial function, smoking hookah is not harmless.
URL: https://www.clinicaltrials.gov . Unique identifiers: NCT03616002 and NCT03067701.
水烟作为一种对青少年无害的香烟替代品进行销售。尽管吸烟会急性损害内皮功能，但吸食水果味水烟烟草的效果尚不清楚。由于传统上是用木炭来加热水烟管中的烟草，因此水烟会输送烟草中的有毒物质和尼古丁，以及木炭燃烧产生的产物：不仅有富含碳的纳米颗粒、可能破坏一氧化氮并损害内皮功能的氧化剂，还有大量的一氧化碳（CO），这是一种潜在的血管扩张分子。
为了测试水烟吸烟对内皮功能的急性影响，我们在年轻的成年水烟吸烟者（n=30，年龄 26±1 岁，平均值±标准差）中，在木炭加热水烟吸烟前后测量了血浆尼古丁、呼出的 CO 和肱动脉血流介导的扩张（FMD）。为了去除木炭燃烧的影响，当相同口味的水烟烟草产品用电加热时（n=20），进行了相同的测量。作为内部阳性对照，我们研究了年龄匹配的香烟吸烟者（n=15），他们吸了 1 支香烟。为了分离 CO 促进对 FMD 的影响，水烟吸烟者（n=8）吸入 0.1%的 CO 混合气，以近似于他们在木炭加热水烟吸烟中获得的 CO 促进效果。
所有类型的吸烟都会导致尼古丁水平相似地增加，而在木炭加热水烟吸烟后，呼出的 CO 增加了 9-10 倍。与电加热水烟或吸烟后相比，FMD 并没有在吸食木炭加热水烟后下降，反而增加了+43±7%（P<0.001）。相比之下，FMD 在吸食电加热水烟后下降了-27±4%（P<0.001），与吸烟后相似。在吸入 CO 气体后，FMD 增加了 138±71%（P<0.001），与在相同受试者中吸食木炭加热水烟后的增加（P<0.001）相比增加了 2.8 倍，尽管呼出的 CO 增加相似（24±1 与 28±3 ppm，水烟与 CO）。
吸食水烟烟草与吸食香烟烟草一样，会急性损害内皮功能。传统的木炭加热水烟吸烟会因木炭燃烧产生的高浓度一氧化碳而掩盖急性内皮功能障碍，而一氧化碳是一种强有力的血管扩张分子。就大动脉内皮功能而言，吸食水烟并非无害。
网址：https://www.clinicaltrials.gov。唯一标识符：NCT03616002 和 NCT03067701。
