Electronic Hookah Vaping: Inflammatory Biomarkers and Biomarkers of Exposure after Acute Exposure

Abstract

Electronic (e‐) hookah vaping has increased in popularity, especially among youth and young adults. Contributing to e‐hookah’s popularity is the unsubstantiated belief that smoke is detoxified as it passes through the water‐filled basin, rendering e‐hookah as a safer alternative to combustible tobacco smoking. With combustible tobacco smoking, vascular inflammation is a key component in the development and progression of atherosclerosis. However, the comparable effects of e‐hookah vaping have not been examined to date. In light of recent outbreaks of vaping‐associated deaths and related‐injuries, it is critical that the use of vaping devices is subjected to scientific scrutiny. Accordingly, the purpose of this work was to elucidate acute effects of e‐hookah vaping on a comprehensive set of systemic vascular inflammatory biomarkers and biomarkers exposure. In 23 young healthy subjects (age 26±1 years, BMI 24.1±0.6 kg·m2, mean±SE) who regularly smoke hookah but do not smoke cigarettes, we measured heart rate, blood pressure, systemic vascular inflammatory biomarkers, including, C□ reactive protein (hsCRP), interleukin‐6 (IL‐6), fibrinogen, and tumor necrosis factor alpha (TNFα), and biomarkers of exposure, including plasma nicotine and exhaled carbon monoxide (CO) before and after a typical 30‐minute session of e‐hookah bowl vaping and, for control comparison, before and after sham smoking (n=8). All biomarkers were measured before and ≤10 minutes after the vaping session. Our results show that after e‐hookah vaping, heart rate and blood pressure increased significantly (Δ heart rate: +9±2 beats.min−1; Δ systolic blood pressure: +16±1 mm Hg, Δ diastolic blood pressure: +10±1 mmHg, p<0.001 as compared with baseline). While nicotine levels increased after vaping (+5.34±1.24 ng/ml, p=0.002), exhaled carbon monoxide levels did not change (p=ns). Notably, plasma indices of systemic vascular inflammation increased significantly (all p<0.05, except for IL‐6: p=ns). All indices were unchanged after sham smoking. Though e‐hookah users endorse marketing claims that these products are safer alternatives to combustible tobacco smoking, our data herein show that despite the absence of combustion, acute exposure to e‐hookah among young healthy adults does not elude adverse cardiovascular effects and, in fact, leads to a transient increase in vascular systemic inflammation. Our data help inform the public about potential cardiovascular disease risk of vaping and guide further studies to examine the chronic long‐term vascular effects of exposure to e‐hookah vaping.Support or Funding InformationThis work was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute 1R21HL145002‐01 and the University of California, Los Angeles Clinical and Translational Science Institute grant UL1TR000124.