Central and Peripheral Hemodynamics in Young Adults Who Use Water Pipes and the Acute Effects of Water-Pipe Use

Hassan A Chami; Maya Diab; Nour Zaouk; Samir Arnaout; Gary F Mitchell; Hussain Isma'eel; Alan Shihadeh

doi:10.1016/j.chest.2023.07.070

Central and Peripheral Hemodynamics in Young Adults Who Use Water Pipes and the Acute Effects of Water-Pipe Use

Chest. 2023 Dec;164(6):1481-1491. doi: 10.1016/j.chest.2023.07.070. Epub 2023 Aug 2.

Authors

Hassan A Chami¹, Maya Diab², Nour Zaouk³, Samir Arnaout³, Gary F Mitchell⁴, Hussain Isma'eel⁵, Alan Shihadeh⁶

Affiliations

¹ School of Medicine, Johns Hopkins University, Baltimore, MD; School of Medicine, American University of Beirut, Beirut, Lebanon. Electronic address: hchami1@jh.edu.
² University of Michigan, Ann Arbor, MI.
³ School of Medicine, American University of Beirut, Beirut, Lebanon.
⁴ Cardiovascular Engineering, Inc., Norwood, MA.
⁵ Aman Hospital, Doha, Qatar.
⁶ School of Engineering, American University of Beirut, Beirut, Lebanon.

PMID: 37541338
DOI: 10.1016/j.chest.2023.07.070

Abstract

Background: Tobacco use via water pipe (commonly referred to as water-pipe smoking [WPS]) is popular among young adults globally and exposes those who smoke to toxicants.

Research question: Is WPS associated with impaired measures of arterial function and does WPS acutely impair these measures in young adults?

Study design and methods: We assessed heart rate (HR), brachial and aortic BP, HR-adjusted augmentation index (AI), and carotid-femoral pulse wave velocity (CFPWV) in 62 individuals who use water pipes and 34 individuals who have never used a water pipe recruited from the community (mean age, 22.5 ± 3.0 years; 48% female). Measurements were obtained before and after an outdoor session of WPS among participants who use water pipes and among the control group of participants who have never used a water pipe. Measurements were compared after vs before exposure and between those who use and those who do not use water pipes, adjusting for possible confounders using linear regression.

Results: Participants who use water pipes and control participants had similar demographic characteristics. BP and HR increased acutely after WPS (brachial systolic BP by 4.13 mm Hg [95% CI, 1.91-6.36 mm Hg]; aortic systolic BP by 2.31 mm Hg [95% CI, 0.28-4.33 mm Hg]; brachial diastolic BP by 3.69 mm Hg [95% CI, 1.62-5.77 mm Hg]; aortic diastolic BP by 3.03 mm Hg [95% CI, 0.74-5.33 mm Hg]; and HR by 7.75 beats/min [95% CI, 5.46-10.04 beats/min]), but not in the control group. AI was significantly higher in participants who use water pipes compared with those who do not (9.02% vs 3.06%; P = .03), including after adjusting for BMI and family history of cardiovascular disease (β = 6.12; 95% CI, 0.55-11.69; P = .03) and when assessing habitual tobacco use via water-pipe extent (water pipes used/day × water-pipe use duration) in water-pipe-years (β = 2.51/water-pipe-year; 95% CI, 0.10-4.92/water-pipe-year; P = .04). However, CFPWV was similar in those who use water pipes and those who do not, and AI and CFPWV did not change acutely after WPS.

Interpretation: In apparently healthy young individuals from the community, habitual WPS was associated with increased AI, a predictor of cardiovascular risk, and one WPS session acutely increased HR and brachial and aortic BP.

Keywords: cardiovascular function; hemodynamics; water-pipe use.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aorta
Blood Pressure / physiology
Cardiovascular Diseases*
Female
Humans
Male
Pulse Wave Analysis
Water Pipe Smoking*
Young Adult