Impact of Water Pipe Tobacco Smoking on High Sensitivity C Reactive Protein Level and Endothelial Function Compared to Cigarette Smoking

Abstract

Waterpipe (WP) tobacco smoking (other terms are hookah, shisha, nargile, arghile and hubble bubbleis) is gaining wide popularity among young and middle aged males and females. Available evidence suggests that the prevalence of WP smoking ranged from 6 to 34% among Middle Eastern adolescents, 5%-17% among American adolescents, and that WP use is increasing globally. Studies on the cardiovascular effects of WP smoking are limited by methodological quality, the novelty of WP epidemic relative to cigarettes, and the highly variable WP tobacco contents. Inflammation and ED are integral components for the initiation and progression of atherosclerosis. These components precede the clinical manifestations of atherosclerosis and cardiovascular events. hs-CRP have been described as an inflammatory biomarker linked to cardiovascularrisk factors and cardiac events. An hs-CRP level of >3 mg/l was independently associated with a 60% excess risk of incident CAD as compared with levels <1 mg/l after adjustment for all Framingham risk variables. FMD; another predictor of cardiovascular risk, is a measure of NO mediated endothelial function that reflects the hyperemic response of the brachial artery to sheer stress. Cigarette smoking has been recognized to be associated with inflammation and impaired endothelial function,but little is known regarding WP smoking. Although several in vitro studies compared WP to cigarette smoke, there are little data regarding the in vivo effect of either type of smoking. Furthermore, WP tobacco is highly variable in content and processing. The apple flavored WP tobacco, despite its popularity, was not well characterized in clinical studies The study was conducted at Alagouza charity hospital and included 77 healthy volunteers, 30 of them are WP smokers, 30 are cigarette smokers and 17 are non smokers as a control group. The study population was subjected to full medical history and physical examination, assessment of hs-CRP level by ELISA test also they had High-frequency ultrasonographic imaging of the brachial artery to assess FMD was done. The study showed that Smokers (including both WP and cigarette smokers) had slightly higher hs-CRP level than non smokers that was statistically non-significant. Absolute hyperemic change (D2-D1) and FMD were significantly smaller in smokers than controls. Number of subjects with endothelial dysfunction (FMD < 10%) were higher in smokers (OR: 5, 95% CI: 1.04-23.87, P = 0.03); although there were no significant differences between WP and cigarette smokers regarding hs-CRP level and its risk categories.There were also no differences regarding and number of subjects with FMD < 10%. All the results were analyzed statistically to detect their significance.