Association between ECG Abnormalities and Hookah and Cigarette Smoking in the MASHAD Cohort Study Subjects

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, resulting in significant cardiovascular morbidity and mortality. In this study, we aimed to assess the association between hookah and cigarette smoking and ECG patterns using Minnesota Coding (MC) system in a large-scale population.Methods: This study utilized data from the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort, involving ۹,۷۰۴ participants aged ۳۵-۶۵ years. Demographic data, physical measurements, smoking habits, and medical histories were collected. Resting ۱۲-lead ECGs were analyzed using the MC system to identify minor and major ECG abnormalities. Statistical analyses included binary logistic regression adjusted for sex, BMI, education, and employment status, as well as chi-squared tests.Results: The final analysis included ۸,۸۲۱ participants. Cigarette users (۹۲.۳% male) had significantly lower BMI and higher employment rates compared to non-smokers, whereas hookah smokers (۹۰.۲% female) had higher BMIs and were predominantly retirees. Cigarette smokers exhibited a higher prevalence of minor ECG abnormalities (۲۵.۶% vs. ۲۰.۲%, p = ۰.۰۰۱), particularly ST-segment elevation, left axis deviation, sinus bradycardia, and high amplitude P-waves. Logistic regression confirmed significant associations for sinus bradycardia (OR: ۱.۶۰۰, ۹۵% CI: ۱.۱۲۷-۲.۲۷۱, p = ۰.۰۰۹) and high amplitude P-waves (OR: ۴.۷۷۵, ۹۵% CI: ۱.۷۷۱-۱۲.۸۸۰, p = ۰.۰۰۲). Hookah smokers had higher rates of left ventricular hypertrophy plus ST-T abnormalities (۷.۹% vs. ۵.۰%, p = ۰.۰۲۷) and a significantly lower prevalence of sinus tachycardia (۰.۳% vs. ۱.۶%, p = ۰.۰۴۲).Conclusion: Cigarette and hookah smoking are associated with specific ECG abnormalities, suggesting significant cardiovascular effects. The persistence of certain abnormalities after adjustment underscores the long-term impact of smoking on cardiac function. Further research is needed to elucidate the mechanisms and mitigate the cardiovascular risks associated with various forms of tobacco use.

Keywords:

Cigarette , Electrocardiogram , hookah , Smoking , tobacco