Investigating the Cardiovascular Toxicity of Exposure to Electronic Hookah Smoking
| Status: | Recruiting |
|---|---|
| Conditions: | Smoking Cessation, Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 21 - 39 |
| Updated: | 3/27/2019 |
| Start Date: | September 15, 2018 |
| End Date: | August 31, 2020 |
| Contact: | Mary Rezk-Hanna, PhD |
| Email: | MRHanna@mednet.ucla.edu |
| Phone: | (310) 206-8654 |
Hookah (water-pipe) smoking has quickly grown to become a major global tobacco epidemic among
youth; with electronic hookahs more recently increasing in popularity especially among young
female adults, who endorse marketing claims that these products are a safer alternative to
traditional hookah, but scientific evidence is lacking. The study aims to elucidate the
comparative effects of traditional hookah smoking vs. electronic hookah inhalation on human
vascular and endothelial function; and examine the role of inflammation and oxidative stress
as likely mechanisms in hookah-related cardiovascular disease pathogenesis.
youth; with electronic hookahs more recently increasing in popularity especially among young
female adults, who endorse marketing claims that these products are a safer alternative to
traditional hookah, but scientific evidence is lacking. The study aims to elucidate the
comparative effects of traditional hookah smoking vs. electronic hookah inhalation on human
vascular and endothelial function; and examine the role of inflammation and oxidative stress
as likely mechanisms in hookah-related cardiovascular disease pathogenesis.
Hookah (water-pipe) smoking is rapidly increasing in popularity worldwide. Contributing to
this popularity is the unsubstantiated belief that traditional hookah smoke is detoxified as
it passes through the water-pipe. More recently, electronic hookah bowls—containing e-liquid
that is heated electrically but inhaled through traditional water-pipes—are increasing in
popularity in the United States among young female adults, who endorse marketing claims that
these products are even safer than traditional hookah. With traditional hookah, in addition
to nicotine and tar, smokers are exposed to carbon-enriched fine particles and significant
amounts of carbon monoxide (CO), the latter of which has been shown to constitute an
endothelial-dependent vasodilator. Though toxicant exposure is much lower than traditional
hookah and without any CO exposure, e-hookah bowls deliver nicotine and fine particles that
constitute putative vascular toxins. The main objective of this project is to investigate the
comparative effects of traditional hookah smoking versus electronic hookah bowl inhalation on
endothelial and vascular function and their mechanistic role in the development of
cardiovascular disease. Specifically, the investigators will examine the role of oxidative
stress and inflammation as potential mechanisms of action in hookah-induced cardiovascular
disease. The investigators will test the hypothesis that; 1) in the absence of charcoal
briquettes and virtually any CO exposure, e-hookah bowl inhalation acutely impairs
endothelial function and evokes acute central stiffness, opposite from the endothelial
function augmentation observed after traditional hookah smoking, which is likely mediated by
the large CO boost emitted from burning charcoal briquettes used to heat the flavored
tobacco; and 2) the processes of oxidative stress and inflammation play a pivotal mechanistic
role underlying these vascular changes. In a cross-over study comparing traditional hookah
smoking to e-hookah bowl inhalation, the investigators will assess endothelial function
measured by brachial artery flow-mediated dilation and aortic stiffness by pulse wave
velocity and augmentation index in 18 young healthy hookah smokers 21-39 years old, before
and after ad lib 30-minute smoking/ inhalation session. To test for oxidative stress
mediation, the investigators will determine if any acute impairment in endothelial function
after e-hookah can be prevented by intravenous Vitamin C infusion, a potent anti-oxidant.
Antioxidant defensive buffers, such as protective HDL or paraoxonase-1 activity, or an
increase in oxidized lipoproteins will be collected. To test for inflammatory mediation,
biomarkers including anti-inflammatory cytokine IL-10 and pro-inflammatory cytokines hsCRP,
TNF-α, IL-6, IL-8 will be collected before and after the sessions as well as smoking exposure
biomarkers (plasma nicotine and expired CO). The results of this proposal: (a) stand to fill
in gaps in our mechanistic understanding of the comparative effect of traditional vs.
e-hookah bowl on vascular and endothelial function; and (b) help inform policy decisions by
the FDA about regulation of hookah products.
this popularity is the unsubstantiated belief that traditional hookah smoke is detoxified as
it passes through the water-pipe. More recently, electronic hookah bowls—containing e-liquid
that is heated electrically but inhaled through traditional water-pipes—are increasing in
popularity in the United States among young female adults, who endorse marketing claims that
these products are even safer than traditional hookah. With traditional hookah, in addition
to nicotine and tar, smokers are exposed to carbon-enriched fine particles and significant
amounts of carbon monoxide (CO), the latter of which has been shown to constitute an
endothelial-dependent vasodilator. Though toxicant exposure is much lower than traditional
hookah and without any CO exposure, e-hookah bowls deliver nicotine and fine particles that
constitute putative vascular toxins. The main objective of this project is to investigate the
comparative effects of traditional hookah smoking versus electronic hookah bowl inhalation on
endothelial and vascular function and their mechanistic role in the development of
cardiovascular disease. Specifically, the investigators will examine the role of oxidative
stress and inflammation as potential mechanisms of action in hookah-induced cardiovascular
disease. The investigators will test the hypothesis that; 1) in the absence of charcoal
briquettes and virtually any CO exposure, e-hookah bowl inhalation acutely impairs
endothelial function and evokes acute central stiffness, opposite from the endothelial
function augmentation observed after traditional hookah smoking, which is likely mediated by
the large CO boost emitted from burning charcoal briquettes used to heat the flavored
tobacco; and 2) the processes of oxidative stress and inflammation play a pivotal mechanistic
role underlying these vascular changes. In a cross-over study comparing traditional hookah
smoking to e-hookah bowl inhalation, the investigators will assess endothelial function
measured by brachial artery flow-mediated dilation and aortic stiffness by pulse wave
velocity and augmentation index in 18 young healthy hookah smokers 21-39 years old, before
and after ad lib 30-minute smoking/ inhalation session. To test for oxidative stress
mediation, the investigators will determine if any acute impairment in endothelial function
after e-hookah can be prevented by intravenous Vitamin C infusion, a potent anti-oxidant.
Antioxidant defensive buffers, such as protective HDL or paraoxonase-1 activity, or an
increase in oxidized lipoproteins will be collected. To test for inflammatory mediation,
biomarkers including anti-inflammatory cytokine IL-10 and pro-inflammatory cytokines hsCRP,
TNF-α, IL-6, IL-8 will be collected before and after the sessions as well as smoking exposure
biomarkers (plasma nicotine and expired CO). The results of this proposal: (a) stand to fill
in gaps in our mechanistic understanding of the comparative effect of traditional vs.
e-hookah bowl on vascular and endothelial function; and (b) help inform policy decisions by
the FDA about regulation of hookah products.
Inclusion Criteria:
- 21-39 years old hookah smokers: smoked hookah >12x in last 12 months
- no history of illicit drugs or marijuana
- no evidence of cardiopulmonary disease by history/ physical
- no diabetes: fasting blood glucose <100 mg/dl
- BP<140/90mmHg
- resting HR<100 bpm
- BMI<30kg•m2
- no prescription medication
Exclusion Criteria:
- exhaled CO>10 ppm (smoking non-abstinence)
- positive pregnancy test
- psychiatric illness
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Phone: 310-562-4348
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