Association between ECG abnormalities and hookah and cigarette smoking in MASHAD cohort study subjects

Articles in Press

Document Type : Research Paper

Authors

1 Mashhad University of Medical Sciences

2 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Brighton and Sussex Medical School, Division of Medical Education, Brighton, UK

4 Heart and Vascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

5 International UNESCO center for Health Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran

10.22038/jctm.2025.79903.1486

Abstract

Introduction: Tobacco use, including cigarette and hookah smoking, is a major public health issue due to its association with cardiovascular disease (CVD). Cigarette and hookah smoking introduce harmful substances that lead to atherosclerosis, endothelial dysfunction, and myocardial ischemia, leading to significant cardiovascular morbidity and mortality. In this study, we aimed to assess the association between hookah and cigarette smoking and ECG patterns using MC in a large-scale population.

Methods: This study utilized data from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort, which involves 9,704 participants aged 35-65 years. Demographic data, physical measurements, smoking habits, and medical histories were collected. Resting 12-lead ECGs were analyzed using the Minnesota Coding (MC) system to identify minor and major ECG abnormalities. Statistical analyses included binary logistic regression adjusted for sex, BMI, education, and employment status and chi-squared tests.

Results: The final analysis included 8,821 participants. Cigarette users (92.3% male) had significantly lower BMI and higher employment rates compared to non-smokers, whereas hookah smokers (90.2% female) had higher BMIs and were predominantly retirees. Cigarette smokers exhibited a higher prevalence of minor ECG abnormalities (25.6% vs. 20.2%, p = 0.001), particularly ST-segment elevation, left axis deviation, sinus bradycardia, and high amplitude P-waves. Logistic regression confirmed significant associations for sinus bradycardia (OR: 1.600, 95% CI: 1.127-2.271, p = 0.009) and high amplitude P-waves (OR: 4.775, 95% CI: 1.771-12.880, p = 0.002). Hookah smokers had higher rates of left ventricular hypertrophy plus ST-T abnormalities (7.9% vs. 5.0%, p = 0.027) and a significantly lower prevalence of sinus tachycardia (0.3% vs. 1.6%, p = 0.042).

Conclusion: Cigarette and hookah smoking are associated with specific ECG abnormalities, suggesting significant cardiovascular effects. The persistence of certain abnormalities after adjustment underscores the smoking long-term impact on cardiac function. More research is needed to elucidate the mechanisms and mitigate the cardiovascular risks associated with various forms of using tobacco.

Keywords

Journal of Cardio-Thoracic Medicine

Articles in Press, Accepted Manuscript
Available Online from 17 March 2025

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