الفهرس 
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Abstract
Summary
Waterpipe (WP) tobacco smoking (other terms are
hookah, shisha, nargile, arghile and hubble bubbleis) is gaining
wide popularity among young and middle aged males and
females. Available evidence suggests that the prevalence of WP
smoking ranged from 6 to 34% among Middle Eastern
adolescents, 5%-17% among American adolescents, and that
WP use is increasing globally. Studies on the cardiovascular
effects of WP smoking are limited by methodological quality,
the novelty of WP epidemic relative to cigarettes, and the
highly variable WP tobacco contents.
Inflammation and ED are integral components for the
initiation and progression of atherosclerosis. These components
precede the clinical manifestations of atherosclerosis and
cardiovascular events. hs-CRP have been described as an
inflammatory biomarker linked to cardiovascular risk factors
and cardiac events. An hs-CRP level of >3 mg/l was
independently associated with a 60% excess risk of incident
CAD as compared with levels <1 mg/l after adjustment for all
Framingham risk variables.
FMD; another predictor of cardiovascular risk, is a
measure of NO mediated endothelial function that reflects the
hyperemic response of the brachial artery to sheer stress.
Cigarette smoking has been recognized to be associated with
inflammation and impaired endothelial function, but little is
known regarding WP smoking.
Although several in vitro studies compared WP to
cigarette smoke, there are little data regarding the in vivo effect
of either type of smoking. Furthermore, WP tobacco is highly
variable in content and processing. The apple flavored WP
tobacco, despite its popularity, was not well characterized in
clinical studies
The study was conducted at Alagouza charity hospital
and included 77 healthy volunteers, 30 of them are WP
smokers, 30 are cigarette smokers and 17 are non smokers as a
control group.
The study population was subjected to full medical
history and physical examination, assessment of hs-CRP level
by ELISA test also they had High-frequency ultrasonographic
imaging of the brachial artery to assess FMD was done.
The study showed that Smokers (including both WP and
cigarette smokers) had slightly higher hs-CRP level than non
smokers that was statistically non-significant. Absolute
hyperemic change (D2-D1) and FMD were significantly
smaller in smokers than controls. Number of subjects with
endothelial dysfunction (FMD < 10%) were higher in smokers
(OR: 5, 95% CI: 1.04-23.87, P = 0.03); although there were no
significant differences between WP and cigarette smokers
regarding hs-CRP level and its risk categories.There were also
no differences regarding and number of subjects with FMD <
10%.
All the results were analyzed statistically to detect their
significance.
Among the study sample, 34 subjects had either hs-CRP
> 3 mg/l (13 subjects) or FMD < 10% (26 subjects) or both (5
subjects) and were considered to have high risk profile
These observations may suggest that smoking generally
has a significant effect on both hs-CRP level and FMD, that
after adjusting for age, BMI, HR, SBP, DPB, and D1, smoking
was found to be a significant predictor for high risk profile.
Cigarette smoking had significant predictive effect, whereas
WP smoking did not have predictive effect on high risk profile;
which needs further confirmation by a more studies.