Table 3.
Studies of cardiovascular effects of WP smoking in adolescents and young adults
| Authors Year | Study design | Study participant characteristics | Exposure measures | Outcomes of interest | Key results | Methodological information |
|---|---|---|---|---|---|---|
| Ahmadian et al.84 2017 | Cross-sectional | N=20 (10 WPS, 10 C) age >20 years (27.6±3.1 for WPS, 26.1±3.6 for C); 100% sedentary male; Aliabad Katoul, Iran | WP Smoking | Hematological parameters | WPS > C for hematological variables (white blood cells, hematocrit, lymphocytes, neutrophils). | Self-reported exposure to WP; participant selection process unspecified, no control for confounding. |
| Alomari et al.62 2018 | Cross-sectional | N=397 (161 WPS, 236 C); 14.5±1.1 years for both WPS and C; 59.6% male WPS, 54.6% male C. Irbid, Jordan | WP smoking; WP frequency | Hemodynamics | Heart rate, DBP, mean arterial BP, and rate pressure product (WPS < C). | Self-reported exposure to WP; convenience sample used; excluded students with hyper – glycemia, tension, lipidemia, choleterolemia; mood disorders, medication that can alter cardiovascular function. |
| Alomari et al.63 2020 | Cross-sectional | N=771 (161 WPS, 69 CS, 295 WPS+CS, 246 C); WPS 14.6±1.1 years; CS 14.6±0.99 years; WPS+CS 14.8±1.0 years, C 14.5±1.1 years); Irbid, Jordan | WP smoking, WP frequency | Hemodynamics | WPS, CS < C for heart rate, DBP, mean arterial BP, and rate pressure product. Results not different when stratified by gender. | Self-reported exposure; convenience sample used; control for confounding including BMI, height, and gender |
| Al-Safi et al.61 2009 | Cross-sectional | N=9648 (N=14310 total) for relevant age group (1803 WPS, 7845 C); 18–33 years; 50% male; all regions of Jordan | WP smoking | Hemodynamics | Diastolic BP, systolic BP, mean arterial BP – WPS > C | Self-reported exposure only, exclusivity of WP or cigarette smoking; convenience sample used; excluded individuals with previously cardiovascular disease. |
| Hawari et al.39 2017 | Cross-sectional | N=138 (69 WPS and 69 C); all participants 18–26 years (mean 22.1 years in WPS group and 21.4 years in C group); 100% males; Jordan | WPS smoking | Cardiopulmonary exercise test | WPS < C for VO2 mL/kg and HR at peak exercise, change in EELV, HRR, Pet CO2, and VE/VCO2; WPS > C for shortness of breath and leg fatigue at mid exercise; WPS < C for exercise time in both bivariate and multivariate analyses. | Self-reported exposure; convenience sample used; relatively small sample size; excluded participants based on BMI, active chronic medical conditions, chronic prescription medications use, illicit drug use, cardiovascular health measures, oxygen saturation; controlled for factors influencing exercise duration in analysis. |
| Selim et al.76 2013 | Cross-sectional | N=70 (30 WPS, 30 CS, 10 C) 25–35 years (28±3 years for WPS, 29±3 for CS and 30±3.6 for C); 100% male; Cairo, Egypt | WP Smoking, WP frequency and duration | Vascular function | Flow mediated dilation (FMD%) – WPS < CS < C; FMD% reduced with increasing duration (year) and frequency per day of WP and for indoor vs outdoor WP smoking. | Self-reported exposure only; convenience sample used; excluded combined smokers, persons with cardiovascular disease, or taking medication affecting vasomotor function. |
| Alomari et al.54 2014 | Pre-post | N=53 (53 WPS) 18–35 years (mean: 22.7±4.8); gender unspecified; Irbid, Jordan | WP smoking session | Hemodynamics | WPS session increased heart rate, DBP, mean arterial BP, rate pressure product, and post-occlusion vascular resistance. Post-occlusion blood flow and venous outflow decreased afterwards. | Controlled WP smoking session; participant selection process unspecified; excluded persons with acute medical conditions, cardiovascular, kidney, or metabolic disease, or those using medications with cardiovascular effect. |
| Alomari et al.55 2015 | Pre-post | N=53 (53 WPS) 18–36 years (22.7±4.8); 64% male; Irbid, Jordan | WP smoking session | Hemodynamics | WPS session slightly decreased forearm post-occlusion blood flow, increased post occlusion vascular resistance, and decreased post occlusion venous outflow. | Controlled WP smoking session; exclusion based on chronic diseases, regular use of prescription medication, pregnancy or breast feeding, cigarette smoking. |
| Cobb et al.60 2012 | Pre-post | N=32 WPS; 21.6±2.7 years; 50% male; 68.9% Non-White; Richmond, VA, US | WP smoking session | Hemodynamics Autonomic cardiac control (frequency domain) |
Heart rate (immediately after), DBP (immediately and 15 mins after), and SBP (15 mins after) increased following smoking WP with tobacco but not tobacco-free WP. Heart rate variability measures – low frequency power and its ratio to high frequency power increased, sample entropy decreased immediately after smoking WP with tobacco but not tobacco-free WP. |
Required abstinence from WP smoking, confirmed objectively; convenience sample; inclusion based on number of tobacco products smoked, objective cardiopulmonary measures, chronic diseases, pregnancy status. |
| Kadhum57 2014 | Pre-post | N=61 (61 WPS) 18–25 years; 80% male; London, UK | WP smoking session | Hemodynamics | DBP, SBP, mean arterial BP and heart rate increased post-smoking; change across WP smoking session not associated with CO. | Controlled WP smoking session; convenience sample; excluded CS, non-WP smokers, individuals with cardiopulmonary disease. |
| Nelson et al.53 2016 | Pre-post | N=28 WPS; 27±1 years; 71.4% male; 32.1% Non-Hispanic White, 50% Non-Hispanic Black, 17.9% Other; US | WP smoking session | Hemodynamics Myocardial blood flow |
DBP, SBP, and mean arterial blood pressures, and heart rate increased significantly after WP smoking. Myocardial blood flow velocity, blood flow, and conductance (1.1–1.5 au/mmHg) increased after WP smoking. |
Required abstinence from WP smoking, confirmed objectively; convenience sample; inclusion criteria based on number of tobacco products smoked, objective cardiopulmonary measures, BMI, pregnancy status. |
| Rezk-Hanna et al.58 2018 | Pre-post | N=48 (48 WPS) 18–34 years (25±4); 65% male; Los Angeles, CA | WP smoking session | Vascular function Hemodynamics |
Central arterial stiffness (augmentation index) and carotidfemoral pulse wave velocity increased post WP; no gender differences. After smoking, increase in heart rate, respiratory rate, brachial artery and aortic DBP and SBP; no gender differences. |
Controlled WP smoking session with objectively measured exposure exhaled CO and plasma nicotine; convenience sample used; exclusion based on chronic systemic disease, drug use, physical evidence of cardiopulmonary disease, sinus rhythm, pregnancy, prescription medication, antioxidant supplementations, pre-smoking exhaled CO ≥10 ppm, psychiatric illness. |
| Rezk-Hanna et al.59 2019 | Pre-post | N=30 WPS, 15 CS; 26±1 years; 62.2% male; 40% Non-Hispanic White, 22.2% Non-Hispanic Black, 7% Hispanic, 20% Asian, 11% Other; US | WP smoking session | Vascular function | FMD – changed by +43±6%, -27±4%, +138±71%, -36±4% after smoking charcoal heated WP, electrically heated WP, 0.1% carbon monoxide, cigarette. | Required abstinence from WP smoking, confirmed objectively; convenience sample; inclusion criteria based on number of tobacco products smoked, healthy cardiopulmonary measures, BMI, pregnancy status. |
| Rezk-Hanna et al.52 2020 | Pre-post | N=21; 24±1 years; 57% male; 38.1% Non-Hispanic White, 33.3% Non-Hispanic Black, 19% Hispanic, 9.5% Other; US | WP smoking session | Hemodynamics Hemodynamics |
DBP, SBP, and mean arterial blood pressures, and heart rate increased significantly 30 minutes after WP smoking Foot skin blood flow reduced and vascular resistance increased respectively, calf muscle blood flow and vascular resistance increased and reduced respectively post-flow; changes sustained until 30 minutes after WP smoking. |
WP smoking session; required abstinence from WP smoking, confirmed objectively; convenience sample; inclusion criteria based on objective cardiopulmonary measures, BMI, pregnancy status. |
| Rezk-Hanna et al.59 2019 | Pre-post | N=30 WPS, 15 CS; 26±1 years; 62.2% male; 40% Non-Hispanic White, 22.2% Non-Hispanic Black, 7% Hispanic, 20% Asian, 11% Other; US | WP smoking session | Vascular function | FMD – changed by +43±6%, -27±4%, +138±71%, -36±4% after smoking charcoal heated WP, electrically heated WP, 0.1% carbon monoxide, cigarette. | Required abstinence from WP smoking, confirmed objectively; convenience sample; inclusion criteria based on number of tobacco products smoked, healthy cardiopulmonary measures, BMI, pregnancy status. |
| Yildirim et al.77 2016 | Pre-post | N=33 (33 WPS); 26.8±6.2 years; 84.8% male | WP smoking session | Electrocardiogram, hemodynamics | DBP, SBP increased; oxygen saturation decreased; dispersions of QT, QTc, P-wave and Tp-Te increased after WP smoking. | Self-reported WPS; convenience sample; excluded persons aged <18 years, cardiovascular morbidity/medication. |
| Zhou et al.56 2017 | Pre-post | N=10 (hookah bar workers); ≥20 years (mean: 26.6±2.8); 20% male; NYC (Manhattan), NY | Air quality of hookah bar exhaled CO, saliva cotinine | Hemodynamics | Non-statistically significant increase in heart rate, SBP, and DBP across work shift. | Objective exposure measured by air sampling and biomarkers; convenience sample used; inclusion limited to people aged ≥20 years, working in hookah bar, and exclusion of pregnant women, current CS; small sample size. |
*WPS: waterpipe smokers. CS: cigarette smokers. C: control.