Measuring the acute cardiovascular effects of shisha smoking: a cross-sectional study

Abstract

ObjectivesTo investigate the acute cardiovascular effects of smoking shisha.DesignA cross-sectional study was carried out in six shisha cafes. Participants smoked shisha for a period between 45 min (minimum) and 90 min (maximum). The same brand of tobacco and coal was used.SettingLondon, UK.ParticipantsParticipants were those who had ordered a shisha to smoke and consented to have their blood pressure, heart rate and carbon monoxide levels measured. Excluded subjects were those who had smoked shisha in the previous 24 h, who smoke cigarettes or who suffered from cardiorespiratory problems.Main outcome measuresBlood pressure was measured using a sphygmomanometer. Pulse was measured by palpation of the radial artery. Carbon monoxide levels were obtained via a carbon monoxide monitor. These indices were measured before the participants began to smoke shisha and after they finished or when the maximum 90 min time period was reached.ResultsMean arterial blood pressure increased from 96 mmHg to 108 mmHg (p < 0.001). Heart rate increased from 77 to 91 bpm (p < 0.001). Carbon monoxide increased from an average of 3 to 35 ppm (p < 0.001). A correlation analysis showed no relationship between carbon monoxide and the other indices measured.ConclusionThe acute heart rate, blood pressure and carbon monoxide levels were seen to rise significantly after smoking shisha. The weak correlation between carbon monoxide levels and the other variables suggests that carbon monoxide levels had not contributed to their significant increase.

A review of the health effects of smoking shisha

“…3 These results were also observed in studies from Jordan and the United Arab Emirates. 16 The parameters described above were notably higher in shisha smokers, compared with cigarette smokers.…”

“…16 The parameters described above were notably higher in shisha smokers, compared with cigarette smokers. 3 Ultimately, in chronic shisha smokers, systolic blood pressure and heart rate remain signifi cantly elevated. 17 People who smoked both shisha and cigarettes were reported to have the highest mean systolic blood pressure and heart rate, across all age groups.…”

“…13 One recent study also noted that acute levels of CO increased signifi cantly, possibly contributing to CO poisoning. 3 In these cases, carboxyhemoglobin levels can reach between 20-30% and patients may present with a loss of consciousness, headaches and shortness of breath. 13 Nicotine levels increase signifi cantly from 2 to 6 ng/ml after smoking shisha for fi ve minutes.…”

“…One study conducted in London in 2013 described shisha smoking as acutely stressful to the cardiovascular system in a similar way to cigarettes, supporting the fact that the action of passing the smoke through water is not 'purifying'. 3 These studies are currently very limited in number, relative to studies on cigarette smoking. Interestingly, a recent study described a disparity among GPs' knowledge of shisha and its effects.…”

The acute effects of Water-pipe smoking on Ankle Brachial Index: A cross-sectional Study

“…These studies demonstrated that waterpipe acutely increases heart rate and blood pressure in consumers [7]. Chronically WPS is shown to be associated with coronary artery disease [8,9]. The ankle brachial index (ABI) is the ratio of the systolic blood pressure (SBP) measured at the ankle to the brachial artery.…”