The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk ...factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).
The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.
Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.
The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk ...factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).
The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.
Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.
The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and ...young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.
The vaping epidemic in the US has been largely attributed to the emergence of pod-based e-cigarette devices. While these devices continue to be promoted as alternatives to cigarettes, their impact on ...cardiovascular and behavioral outcomes remains incompletely understood. This study assessed the impact of pod-based e-cigarettes on peripheral and cerebral vascular function, along with subjective experiences among adult cigarette smokers.
In a crossover laboratory design study, a total of 19 (e-cigarette naïve) cigarette smokers (aged 21-43 years) attended two lab sessions. In one session, participants smoked a cigarette and in the other, vaped a pod-based e-cigarette. Participants completed questions assessing subjective experiences. Peripheral macrovascular and microvascular function was assessed via brachial artery FMD and reactive hyperemia, while cerebral vascular function was assessed as the blood velocity response of the middle cerebral artery during hypercapnia. Measurements were taken before and after exposure.
Compared with baseline, there was a reduction in peripheral macrovascular function (indexed by FMD), following e-cigarette (pre=9.3±4.3%; post=6.4±4.1%) and cigarette use (pre=10.2±3.7%; post=6.8±3.8%; main effect of time p<0.0001). Cerebral vascular function (indexed by cerebral vasodilatory response during hypercapnia) was also reduced following e-cigarette (pre=53±19%; post=44±15%) and cigarette use (pre=54±21%; post=44±17%; main effect of time p<0.01). The magnitude of reduction in peripheral and cerebral vascular function was similar between conditions (condition × time, p>0.05). Compared with vaping an e-cigarette, participants scored higher for measures of satisfaction, taste, puff liking, and suppression of craving following smoking (p>0.05).
Similar to smoking, vaping a pod-based e-cigarette leads to an impairment in peripheral and cerebral vascular function while providing a reduced subjective experience compared with a cigarette among adult smokers. While these data challenge the notion that e-cigarette use is a safe and satisfactory alternative to cigarette use, large longitudinal studies are needed to assess the long-term impact of pod-based e-cigarette devices on cardiovascular and behavioral outcomes.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background Electronic hookah (e-hookah) vaping has increased in popularity among youth, who endorse unsubstantiated claims that flavored aerosol is detoxified as it passes through water. However, ...e-hookahs deliver nicotine by creating an aerosol of fine and ultrafine particles and other oxidants that may reduce the bioavailability of nitric oxide and impair endothelial function secondary to formation of oxygen-derived free radicals. Methods and Results We examined the acute effects of e-hookah vaping on endothelial function, and the extent to which increased oxidative stress contributes to the vaping-induced vascular impairment. Twenty-six healthy young adult habitual hookah smokers were invited to vape a 30-minute e-hookah session to evaluate the impact on endothelial function measured by brachial artery flow-mediated dilation (FMD). To test for oxidative stress mediation, plasma total antioxidant capacity levels were measured and the effect of e-hookah vaping on FMD was examined before and after intravenous infusion of the antioxidant ascorbic acid (n=11). Plasma nicotine and exhaled carbon monoxide levels were measured before and after the vaping session. Measurements were performed before and after sham-vaping control experiments (n=10). E-hookah vaping, which increased plasma nicotine (+4.93±0.92 ng/mL,
<0.001; mean±SE) with no changes in exhaled carbon monoxide (-0.15±0.17 ppm;
=0.479), increased mean arterial pressure (11±1 mm Hg,
<0.001) and acutely decreased FMD from 5.79±0.58% to 4.39±0.46% (
<0.001). Ascorbic acid infusion, which increased plasma total antioxidant capacity 5-fold, increased FMD at baseline (5.98±0.66% versus 9.46±0.87%,
<0.001), and prevented the acute FMD impairment by e-hookah vaping (9.46±0.87% versus 8.74±0.84%,
=0.002). All parameters were unchanged during sham studies. Conclusions E-hookah vaping has adverse effects on vascular function, likely mediated by oxidative stress, which overtime could accelerate development and progression of cardiovascular disease. Registration URL: https://ClinicalTrials.gov. Unique identifier: NCT03690427.
Abstract Hookah (water pipe) smoking is a major new understudied epidemic affecting youth. Because burning charcoal is used to heat the tobacco product, hookah smoke delivers not only nicotine but ...also large amounts of charcoal combustion products, including carbon-rich nanoparticles that constitute putative coronary vasoconstrictor stimuli and carbon monoxide, a known coronary vasodilator. We used myocardial contrast echocardiography (MCE) perfusion imaging with intravenous lipid shelled microbubbles in young adult hookah smokers to determine the net effect of smoking hookah on myocardial blood flow. In nine hookah smokers (age 27±5 years, mean±SD), we measured myocardial blood flow velocity (β), myocardial blood volume (A), myocardial blood flow (A x β) as well as myocardial oxygen consumption (MVO2 ) before and immediately after 30 minutes of ad lib hookah smoking. Myocardial blood flow did not decrease with hookah smoking but rather increased acutely (88±10 to 120±19 a.u.·s-1 , mean±SE, p=0.02), matching a mild increase in MVO2 (6.5±0.3 to 7.6±0.4 ml·min-1 , p<0.001). This was manifested primarily by increased myocardial blood flow velocity (0.7±0.1 to 0.9±0.1 s-1 , p=0.01) with unchanged myocardial blood volume (133±7 to 137±7 a.u., p=ns), the same pattern of coronary microvascular response seen with a low-dose β-adrenergic agonist. Indeed, with hookah, the increased MVO2 was accompanied by decreased heart rate variability, an indirect index of adrenergic over-activity, and eliminated by β-adrenergic blockade (i.v. propranolol). In conclusion, nanoparticle-enriched hookah smoke either is not an acute coronary vasoconstrictor stimulus or its vasoconstrictor effect is too weak to overcome the physiologic dilation of coronary microvessels matching mild cardiac β-adrenergic stimulation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract only Introduction: Flavored hookah tobacco smoking among young adults continues to be a public health concern. While short-term exposure to flavored hookah tobacco smoking impairs vascular ...function, data on the long-term impact of habitual use are not clearly delineated. Research Question: Is habitual flavored hookah tobacco smoking associated with vascular endothelial dysfunction in young healthy adults? Goals: Investigate the impact of regular flavored hookah tobacco smoking on vascular endothelial function, as compared to regular cigarette smoking and never tobacco use, in young healthy adults. Methods: We assessed brachial artery flow-mediated dilation (FMD)—a well-established index of vascular endothelial function—in 22 exclusive chronic hookah smokers (25±1 years of age, 23% women; mean±SE), who reported smoking flavored hookah tobacco on average two times per week for 9±1 years, 22 exclusive cigarette smokers who reported 4±1 pack years, and 23 non-smokers. FMD and vascular endothelium-independent nitroglycerin-mediated vasodilation was assessed using high resolution ultrasound. Results: Whereas baseline brachial artery diameter was comparable between groups ( P =ns), brachial artery FMD was significantly lower in habitual hookah users and cigarette users as compared to never smokers (cigarette smokers: 5.22±0.42; hookah smokers: 6.43±0.50; non-smokers: 9.80±0.83; P <0.05). Endothelium-independent dilation of the brachial artery in response to sublingual nitroglycerin did not significantly differ between groups. Conclusions: Despite claims of safety advertised by the growing hookah tobacco industry, our findings provide evidence that, as compared to non-tobacco users, young and apparently healthy adults who regularly smoke flavored hookah tobacco exhibit reduced vascular endothelial function. These results suggest that flavored hookah tobacco smoking is not without harm and has potential harmful vascular effects, associated with increased cardiovascular disease risk.
Smoking is a major cause of cardiovascular morbidity and mortality worldwide. Over recent years, alternative forms of traditional tobacco smoking have emerged, including electronic (e‐) cigarettes ...and e‐hookah bowls, with claims that they are safer tobacco alternatives. Unlike e‐cigarettes, e‐hookah bowls are used through traditional water‐pipes, allowing the vapor—containing aerosolized nicotine, propylene glycol, glycerin, and flavorings—to pass through a water‐filled base, potentially altering the vapor, before it is inhaled to the user's mouth. While e‐cigarettes have been shown to cause acute endothelial dysfunction, the effect of e‐hookah is unknown. In eight overtly healthy, young, male adult hookah smokers who do not smoke cigarettes (age 25±3 years; body mass index, BMI 23.9±2.7 kg·m2 mean±SD), we measured heart rate, blood pressure and endothelial function (as measured by brachial artery flow‐mediated dilation (FMD)) before and after a 30‐minute e‐hookah smoking session. Hookah smoking increased heart rate (Δ heart rate: +10±13 beats.min−1) and blood pressure (ΔSBP: +12±7 mm Hg; ΔDBP: +8±5 mm Hg). Importantly, after e‐hookah smoking, FMD decreased from 6.59 ± 2.61 to 5.33 ± 1.97 %Δ, indicating impaired endothelial function. As functional impairment of the endothelium is one of the first recognizable signs of development of atherosclerosis, this new preliminary data provide an initial line of scientific evidence to counter claims that smoking e‐hookah is a safe tobacco alternative. Future studies are indicated to elucidate the long‐term effects of e‐hookah smoking on vascular health, which overtime could accelerate the development of cardiovascular diseases.
This is from the Experimental Biology 2019 Meeting. There is no full text article associated with this published in The FASEB Journal.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Smoking is a major cause of cardiovascular morbidity and mortality worldwide. Hookah (ie, waterpipe) smoking is a centuries-old revived yet understudied global epidemic of tobacco use. Because of the ...traditional set-up of a hookah-pipe, in addition to inhaling tobacco-combustion products, smokers are also exposed to large amounts of charcoal combustion products from the burning charcoal briquettes used to heat the hookah flavored tobacco. Despite being heavily advertised and actively glamorized in the mass media as a healthier tobacco alternative, the toxicological constituents of hookah smoke-including nicotine, carbon monoxide, particulates, oxidants, heavy metals, phenols and flavorants-indicate the potential to cause adverse cardiovascular events.
Herein, we review evidence on hookah smoke toxicological constituents, cardiovascular effects and potential mechanisms by which hookah smoke aerosol could cause cardiovascular disease.
The evidence reviewed here indicates that contrary to the widespread popular belief that hookah is a healthier tobacco alternative, the constituents of hookah smoke aerosol contains similar chemicals compared to cigarette smoke, many of which are known to be harmful to cardiovascular health and mediated by similar pathophysiologic processes. Because the burning charcoal briquettes are a unique source of toxicant emissions specific to hookah smoking, some constituents differ in their quantities from cigarettes with some of their cardiovascular effects unknown.
To date, much more is known about the constituents and their toxicology than about the effects of hookah smoking on human cardiovascular health. Further research on long-term consequences of hookah use is needed.
This review provides an overview on the potential impact of hookah smoking on cardiovascular health. Readers will gain an insight into evidence on its toxicological constituents, human health effects, and pathophysiological mechanisms by which hookah smoking might cause cardiovascular disease. The review also highlights current research gaps regarding the cardiovascular consequences of hookah smoking, specifically the long-term consequences in the United States and Europe among flavored-hookah tobacco users.
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