The effects of vaping on vascular health

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Hookah smoking or vaping is usually done in social environments and smoked or vaporized among groups in cafes or hookah lounges

Mary Rezk-Hanna, PhD at the University of California, Los Angeles, studies the short-term effects of vaping on vascular health – she argues that e-vaping is harmful and that a “safer” alternative to traditional hookah is anything but sure

While smoking rates among school-aged children and young adults have reached historic lows, the use of electronic nicotine delivery systems (ENDS) has increased exponentially in recent years. ENDS are battery operated devices that produce an inhaled aerosol that delivers nicotine, fine and ultrafine particles and aromas, without any combustion. Smoking refers to the inhalation of smoke generated by the combustion of tobacco, while vaping refers to the inhalation of aerosols generated by electronic distribution systems.

In 2003, electronic cigarettes (e-) entered the market, then in 2007 they were patented internationally. Since their introduction, their designs and manufacturing processes have evolved and different NDTs have developed including JUUL and e-hookahs. In 2014, e-hookahs were introduced as a new category of NDT and marketed as a “safer” alternative to fuel-flavored hookah tobacco smoke. More recently, in 2019, e-hookahs were patented by Philip Morris.

Prevalence and health effects of e-hookahs

Compared to other ENDS, including electronic cigarettes, little is known about the prevalence and health effects of e-hookahs. According to data from the large nationally representative study of the U.S. population on tobacco and health, although e-hookahs are used less than e-cigarettes, the use of e-hookahs among young people and adults is not uncommon.

Among adults ≥18 years old, 4.6% said they had ever used an e-hookah and among them, more than a quarter (26.8%) reported current use, compared to cigarette use electronics which was reported by 22.5% with 24.8% reporting current use. Among 12 to 17 year olds, 7.7% were identified as having ever used electronic hookahs and 14.3% were electronic cigarette users. It is important to note that this data reflects the prevalence rates between 2013-2014, before e-hookahs entered the market. Indeed, further studies are needed to fully characterize the potential increase in prevalence, user characteristics, smoking habits and behaviors specific to e-hookah use.

vascular health, hookah

Regarding the potential harm from ENDS, all translational studies to date have focused on e-cigarettes. Therefore, little is known about e-hookahs. Although both products fall under the ENDS category, the distinct characteristics of each product must be taken into account when extrapolating data comparing the two. Electronic hookahs are combined and placed over traditional water pipes, allowing the aerosol to pass through a basin filled with water, cooling and potentially modifying the aerosol, before being inhaled by the user. Thus, electronic hookahs reproduce unique aspects of traditional water pipe smoking, a tobacco product that is centuries old but little studied. What differentiates hookah products from all other forms of tobacco products and nicotine delivery systems is the fact that smoking or vaping of the hookah is usually done in social settings and smoked or vaporized among groups in cafes or hookah lounges. Another key difference between hookah products and other alternative tobacco products is the length of the smoking or vaping session, which can last for hours.

Research in the field

Studies highlight this in relation to electronic cigarette products; E-hookah products are more likely to be offered in fruit flavors that do not contain nicotine. This is because hookah tobacco and vaping companies heavily market their customizable products to target teens and young adults, as evidenced by the flashy flavors of fruit, candy and alcohol widely available, compared to e-cigarettes which are widely available. are often marketed as tools to help adults. stop smoking cigarettes. In a study that explored perceptions of NDT among teens and young adults, e-hookah users were seen as young, cool, on the cutting edge of technology, compared to e-cigarette users who were perceived to be like older and addicted to nicotine. .

Since the human health effects of hookah tobacco and related electronics remain incompletely characterized, cardiovascular scientist Professor Rezk-Hanna and colleagues at the University of California, Los Angeles, conducted a design study. randomized crossover to examine the difference in short-term vascular effects resulting from traditional hookah smoking and e-hookah vaping.

The study included a group of 17 healthy young adults, aged 21 to 39, who were asked to vape a single 30-minute e-hookah session and smoke a single 30-minute hookah session out of two. separate days, separated by a week. a part. The researchers measured arterial stiffness and collected blood to examine changes in inflammation and oxidative stress in participants before and after the sessions. The study found that a single session of e-hookah or hookah vaping significantly increased artery stiffness – a strong and independent predictor of cardiovascular mortality – with e-hookah vaping suggesting a larger increase. Compared with traditional fuel hookah, the vascular changes associated with e-hookah vaping were accompanied by an acute increase in pro-inflammatory biomarkers.

These studies suggest that even in obviously healthy young adults, e-hookah vaping transiently leads to an accelerated increase in arterial stiffness and an increase in systemic inflammation, both of which could put them at an increased risk of heart disease. These new findings support growing concerns about the use of ENDS by young people raised by the scientific research community and challenge claims of “so-called” harm reduction by the tobacco industry.

Closing remarks

A key point to consider is the fact that ENDS is evolving much faster than scientific research to inform their regulation. Shisha tobacco and vaping products vary widely in the characteristics and content of the products, including the bioavailability of nicotine and flavors. This lack of uniformity has hampered scientific efforts to characterize the specific constituents leading to potential harm as well as to clearly describe the effects on human health, compared to the known effects of consuming traditional cigarettes.

“People who are vaping or considering vaping are encouraged to recognize the following two points: 1.Nicotine is as addictive as cocaine or heroin and that even without nicotine, vaping flavors alone have been shown to have negative impact on vascular health; and 2. Due to the non-linear dose-response relationship of combustible cigarettes having consequences for cardiovascular disease, complete cessation should be the ultimate goal (compared to vaping to reduce the frequency of smoking). said Dr Rezk-Hanna.

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Rezk-Hanna M, Gupta R, Nettle CO, et al. Differential effects of electronic hookah vaping and traditional combustible hookah smoking on oxidation, inflammation and arterial stiffness. Chest. July 21, 2021; doi: 10.1016 / j.chest.2021.07.027

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