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Hookah smoke may be associated with increased risk of blood clots

January 16, 2020

DALLAS, Jan. 16, 2019 - For the first time, in a study conducted in mice, researchers found that tobacco smoke from a hookah caused blood to function abnormally and be more likely to clot and quickly form blood clots, which can increase the risk of heart attack or stroke, according to new research published today in the American Heart Association's journal Arteriosclerosis, Thrombosis and Vascular Biology (ATVB).

Researchers found that tobacco smoke from a hookah caused blood clots to form within an average of about 11 seconds, compared to an average of 5 minutes for clotting without exposure to hookah smoke. Exposure to the hookah smoke also caused other abnormalities related to the way the blood flows.

"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 Fadi Khasawneh, Ph.D., associate professor and chair of pharmaceutical sciences at The University of Texas at El Paso.

Hookah, also known as waterpipe smoking, is a unique method of smoking tobacco. It consists of a head (which holds the tobacco), a body, a chamber filled with water, a hose and a mouthpiece. Charcoal briquettes are used to "burn" the tobacco.

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.

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.

"Our findings provide new evidence that hookah smoking is as unhealthy - if not more so - than traditional cigarettes," Khasawneh said. "Smoking a hookah, cigarettes, e-cigarettes or other forms of tobacco all increase your risk for heart disease and stroke."

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."
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Co-authors are Ahmed Alarabi, M.D., M.P.H.; Zubair Karim, Ph.D.; Jean Ramirez, M.S.; Keziah Hernandez, M.P.A.; Patricia Lozano, M.S.; Jose Rivera, Pharm.D.; and co-leader of the study Fatima Alshbool, Pharm.D., Ph.D. Author disclosures are in the manuscript.

The National Institute of Environmental Health Sciences and the National Heart, Lung, and Blood Institute of the National Institutes of Health partially funded the study.

Additional Resources:

Available multimedia is on right column of release link: https://newsroom.heart.org/news/hookah-smoke-may-be-associated-with-increased-risk-of-blood-clots?preview=af107c8b13edca33d551ee5949d6a212

After 4 a.m. CT / 5 a.m. ET Thursday, Jan. 16, 2019, view the manuscript online.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https://www.heart.org/en/about-us/aha-financial-information.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

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