Acute Effect of Hookah Smoking on Arterial Stiffness and Wave Reflections in Adults Aged 18 to 34 Years of Age

Am J Cardiol. 2018 Sep 1;122(5):905-909. doi: 10.1016/j.amjcard.2018.05.033. Epub 2018 Jun 5.


Hookah (waterpipe) smoking is rapidly increasing in popularity worldwide. Despite being heavily advertised in the media as a healthier alternative to cigarettes, the toxicology of hookah smoke suggest otherwise. Cigarette smoking unequivocally causes an acute increase in arterial stiffness, but whether hookah does the same is unknown. In 48 young healthy habitual hookah but not cigarette smokers, we measured heart rate, peripheral and central blood pressure, carotid-femoral pulse wave velocity (measure of arterial stiffness), aortic augmentation index (measure of wave reflection), plasma nicotine, and exhaled carbon monoxide before and after ad lib hookah smoking. Hookah smoking increased heart rate by +16 ± 1 beats/min and mean brachial arterial pressure by +6 ± 1 mm Hg (both p <0.05, mean ± SE). Most importantly, it increased carotid-femoral pulse wave velocity and aortic augmentation index by +0.66 ± 0.09 m/s-1 and +8.76 ± 3.99%, respectively (p <0.05, mean ± SE), denoting increased acute arterial stiffness. These vascular effects were accompanied by increases in plasma nicotine concentration (+5.8 ± 1.2 ng/ml, p <0.05) and expired carbon monoxide (+25.44 ± 1.68 ppm, p <0.05). All these parameters were unchanged during time-control studies (n = 14). Thus, in contrast to effective media marketing of hookah as a safer alternative to cigarettes, the present study shows for the first time that in young adult hookah smokers, a single hookah smoking session causes an acute increase in arterial stiffness of comparable magnitude to what has been previously reported for cigarettes. Further research is warranted to determine whether habitual hookah smoking accelerates the age-dependent development of hypertension and its cardiovascular complications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Blood Pressure / physiology
  • Brachial Artery / physiopathology
  • Electrocardiography
  • Heart Rate / physiology
  • Humans
  • Male
  • Nicotine / blood
  • Pulse Wave Analysis
  • Vascular Stiffness*
  • Water Pipe Smoking*


  • Nicotine