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Smoking causes deadly blood clots


*Shisha increases risk of heart attacks, strokes, complications after surgery
Smoking trendy hookah pipes (shisha) may increase your risk of a heart attack or strokes by causing deadly blood clots, scientists fear.

The tabletop pipes are considered to be ‘healthier’ because the smoke goes through water before inhalation.

But for the first time, research on mice has shown hookah smoke causes blood cells to become ‘hyperactive’.

Experiments led by the University of Texas, United States (U.S.), found the blood of the rodents clotted at a rate five times faster than normal.

Experts did not study whether the clots caused heart attack or strokes – but they are a known cause of the killer cardiac events by blocking vessels.

The findings suggest shisha is no less dangerous than smoking traditional cigarettes, a habit already known to threaten heart health.

Study co-author, Dr. Fadi Khasawneh, said: “Hookah smoking, which is becoming more popular in Western countries, is perceived as less harmful than cigarettes.

“Yet hookahs carry a toxic profile that is thought to be comparable or to even exceed that of traditional cigarettes. Our findings provide new evidence that hookah smoking is as unhealthy – if not more so – than traditional cigarettes.”

Hookah pipes have grown in popularity in recent years, with figures suggesting up to a fifth of young people in the United States (U.S.) and Europe using them.

Hookah is an ancient form of smoking in which charcoal-heated tobacco or non-tobacco based shisha smoke is passed through water before inhalation.

Smoking cigarettes alone is already known to be a key risk factor for stroke because the killer habit thickens the blood.

Previous studies have suggested hookah smoking also threatens cardiovascular health.

But this is the first to demonstrate its effect on blood. It was published in the American Heart Association’s journal Arteriosclerosis, Thrombosis and Vascular Biology (ATVB).

Mice were exposed to hookah smoke from a smoking machine for an hour every day for one week in the lab.

Meanwhile, tobacco smokers are at significantly higher risk than non-smokers for post-surgical complications including impaired heart and lung functions, infections and delayed or impaired wound healing.

But new evidence reveals that smokers who quit approximately four weeks or more before surgery have a lower risk of complication and better results six months afterwards. Patients who quit smoking tobacco are less likely to experience complications with anesthesia when compared to regular smokers.

A new joint study by the World Health Organization (WHO), the University of Newcastle, Australia and the World Federation of Societies of Anaesthesiologists (WFSA), shows that every tobacco-free week after 4 weeks improves health outcomes by 19 per cent, due to improved blood flow throughout the body to essential organs.

“The report provides evidence that there are advantages to postponing minor or non-emergency surgery to give patients the opportunity to quit smoking, resulting in a better health outcome,” said Dr. Vinayak Prasad, Head of Unit, No Tobacco, World Health Organisation.

The Nicotine and carbon monoxide, both present in cigarettes, can decrease oxygen levels and greatly increase risk of heart-related complications after surgery. Smoking tobacco also damages the lungs making it difficult for the proper amount of air to flow through, increasing the risk of post-surgical complications to the lungs. Smoking distorts a patient’s immune system and can delay healing, increasing the risk of infection at the wound site. Smoking just one cigarette decreases the body’s ability to deliver necessary nutrients for healing after surgery.

“Complications after surgery present a large burden for both the health care provider and the patient. Primary care physicians, surgeons, nurses and families are important in supporting a patient to quit smoking at every stage of care, especially before an operation,” explained Dr. Shams Syed, Coordinator, Quality of Care, WHO. WHO encourages countries to include cessation programmes and educational campaigns in their health systems to spread awareness and help people to quit smoking.

What is hookah? Hookah is an ancient form of smoking, also called narghile, waterpipe, or hubble bubble smoking, which uses charcoal-heated tobacco or non-tobacco based shisha smoke which is passed through water before inhalation.

It is often seen as less toxic compared to cigarettes, alongside e-cigarettes and vaping.

The sweet flavours available make shisha smoking desirable, especially the young people – around half the smoking teenagers do is in this way.

Hookah smokers can spend long periods of time in lounges and bars inhaling the fumes.

A typical hookah session lasting one hour involves 200 puffs, which results in 90,000 milliliters of smoke being inhaled.

Smoking a cigarette involves 20 puffs, resulting in 500-600 milliliters of smoke being inhaled, according to the United States Centers for Disease Control and Prevention.

World champion sprinter Usain Bolt and Manchester City striker Sergio Aguero have both been pictured smoking shisha.

And musicians including Drake, Katy Perry and Kylie Minogue have all been pictured using a hookah in recent years.

But mounting evidence finds smoking shisha is not safe.

The smoking machine used 12g of flavoured tobacco with nicotine and tar, typical to that seen in a usual waterpipe set-up.

Researchers carried out experiments on the last day of the study and examined the effects of hookah smoke on blood function.

They made a small incision on the tails of the mice and measured how quickly the blood responded to the injury.

This is known as haemostasis, when the blood clots to form a plug and stop the bleeding.

It took an average of 11 seconds for the smoke-exposed mice to stop bleeding, four minutes and 40 seconds quicker than mice who were healthy.

Next, the team examined if the smoke-exposed mice were more prone to thrombrosis – when a blood clot forms without bleeding.

While the mice were under anaesthesia, the scientists injured the carotid artery in the neck, which supplies blood to the brain.

This mimicked the first process of a heart attack, in which a piece of plaque breaks off a blood vessel wall.

The scientists measured how long it took for a blood clot to form inside the artery and halt blood flow. A blockage in arteries caused by a blood clot can trigger a heart attack or stroke, depending on where it is. It took one minute and 12 seconds in the smoke-exposed mice, compared with six minutes in the healthy mice.

The researchers blamed ‘hyperactivity’ in the platelets, triggered by the hookah smoke, for the abnormally fast blood processes.

Although mice are very small, the findings are applicable to humans, the researchers said.

They made sure that cotinine, a chemical found in tobacco which can be measured in the blood, was comparable to that found in humans who smoke hookah.

Dr Khasawneh said: “Some studies have found that the smoke emitted from one hookah tobacco smoking episode contains significantly more harmful chemicals compared to a single cigarette.

“Smoking a hookah, cigarettes, e-cigarettes or other forms of tobacco all increase your risk for heart disease and stroke.”

It is not the first time experts have warned of the dangers of shisha, which has been found equal to or worse than smoking a pack of cigarettes.

In May 2019, the American Heart Association (AHA) published a statement on hookah smoking based on current evidence.

It reinforced that hookah smoke still contains toxic chemicals such as carbon monoxide which cam harm blood vessels, the heart and lungs.

Dr. Aruni Bhatnagar, a director of AHA Tobacco Center for Regulatory Science, said: “This study provides additional evidence that, contrary to popular belief, hookah smoking adversely affects cardiovascular health.

“From 2011 to 2015, the number of United States-based waterpipe establishments is estimated to have more than doubled, and interest has grown among both teens and adults.

“Although the tobacco industry has found novel ways to popularize and increase the use of new products, studies like this highlight the high risk of hookah smoking.”

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