Blood lipids and pressures data of exclusive narghile smokers compared with healthy non-smokers: studies from thin to thick

Abstract

Dear Editor, I read with great interest the recent paper of Hallit et al. (2019) highlighting the damaging effects of narghile-use on some cardiovascular risk factors [e.g., total cholesterol (TC), lowand highdensity lipoprotein cholesterol (LDL-C, HDL-C, respectively)]. Hallit et al. (2019) study is interesting because disregarding the critical effects of narghile-use on blood lipids and pressures data will surely lead to a worldwide public health problem, which physicians can undertake to prevent (Ben Saad 2009; Ben Saad 2010; Hasni et al. 2019; WHO 2015). Moreover, according to the 2015 World Health Organization advisory note on narghile-use (WHO 2015), further research related to the narghile-associated disease risk was recommended. However, three important points should be highlighted. First, Hallit et al. (2019) omitted to identify the type of usednarghile tobacco (moassel and/or jurak and/or tombak). The lack of this important information makes between-studies comparisons complicated (Ben Saad 2009; Hasni et al. 2019). This point is capital since in the case of tombak (often used in Saudi Arabia (Ben Saad 2010)) in comparison to tabamel and/or jurak (often used in Tunisia (BenHadjMohamed and Ben Saad 2016; Hasni et al. 2019)), the pattern is different (Ben Saad 2009). For example, in the recent Tunisian study having a similar aim as the one of Hallit et al. (2019), no tombak smoker was included, and the percentages of smokers of jurak, moassel, and both jurak and moassel were 13.8, 72.4, and 13.8%, respectively. Secondly, the inclusion of a higher frequency of exclusive narghile smokers (ENS) who were regular alcohol consumers (68% in the study of Hallit et al. (Hallit et al. 2019)) needs a deep discussion. This point is a source of confusion since it influences some lipid data (Hasni et al. 2019). For example, it was previously recognized that alcohol consumption increases HDL-C in a dose-dependent manner, linked with and probably caused by, a rise in the transport rate of HDL apolipoproteins apoA-I and -II (De Oliveira et al. 2000). Moreover, a meta-analysis suggested that very light alcohol drinking is related with a reduced risk of metabolic syndrome, while heavy alcohol drinking is linked with an increased risk of this syndrome (Sun et al. 2014). As done by Hasni et al. (2019), it was better to report additional comparative data after exclusion of alcohol consumers. The aforementioned two points can together explain a big part of the discrepancy between data reported by the Lebanese study (Hallit et al. 2019) and those of a recent Tunisian one (Hasni et al. 2019) concerning the effects of narghile-use on both blood lipids and pressures. While in the Lebanese study (Hallit et al. 2019), compared to healthy non-smokers (HNS), ENSs had higher mean of TC, LDL-C, diastolic blood pressure (DBP), and had lower HDL-C; in the Tunisian one (Hasni et al. 2019), the two groups were matched with TC, HDL-C, LDL-C, and DBP values. According to the literature, the effects of narghile-use on blood pressures are controversial: compared to HNSs, ENSs had similar values of both systolic blood pressure (SBP) and DBP (Hasni et al. 2019), had higher values of both SBP and DBP (Shafique et al. 2012), or had higher values of only DBP (Ben Saad et al. 2014; Hallit et al. 2019). Likewise, the effects of narghile-use on blood lipids data are also controversial. Compared to HNSs, ENSs had similar TC values (Hasni et al. 2019; Koubaa et al. 2015), lower TC values (Saffar Soflaei et al. 2018), or higher TC values (Hallit et al. 2019) and had similar HDL-C values (Al Mutairi et al. 2006; Hasni et al. 2019; Shafique et al. 2012) or Responsible editor: Philippe Garrigues