title: Impact of shisha smoking on the extent of coronary artery disease in patients referred for coronary angiography.
abstract: OBJECTIVE
  To study the impact of shisha smoking on the extent of coronary artery disease.
  
  
  METHODS
  Patients who underwent coronary angiography were included in this observational cohort study and were divided to four groups according to the smoking pattern: shisha smokers, cigarettes smokers, mixed smokers (shisha and cigarettes) and non-smokers. Coronary angiography was done and the severity of coronary artery disease was defined according to Duke Jeopardy Score (DJ).
  
  
  RESULTS
  The study comprised of 287 consecutive patients; 22% were shisha smokers, 35% cigarette smokers, 5% mixed smokers and 38% non-smokers. Significant elevation of systolic blood pressure (p=0.009) and heart rate (p<0.001) were observed among mixed smokers followed by shisha smokers, cigarettes smokers and non-smokers respectively. The mean value of DJ score was highest among shisha smokers than mixed smokers, cigarettes smokers and non-smokers respectively (p=0.012). We also compared DJ score in shisha smokers with CAD vs non-shisha smokers with CAD and we found that 71.43% of shisha smokers had an advanced DJ score (>6) which was statistically significant (p=0.008) where shisha smokers showed significantly higher resting pulse (p<0.001) and systolic blood pressure (p=0.001) compared to non-shisha smokers and mean DJ score was significantly higher among shisha smokers (6.961±3.238) vs non-shisha smokers (5.762±3.062) (p=0.004).
  
  
  CONCLUSIONS
  Shisha smoking is associated with severe coronary artery disease that calls for the need to enroll them in tobacco cessation courses.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo-Egypt. Ghadaselim23@yahoo.com.
authors.forename: Ghada M
authors.initials: GM
authors.lastname: Selim
authors.forename: Hany
authors.initials: H
authors.lastname: Fouad
authors.forename: Samy
authors.initials: S
authors.lastname: Ezzat
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D062789:Tobacco Products