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Highlights: Hookah smoke contains very high levels of toxic chemicals even more than that present in cigarettes Hookah smoking affects blood pressure, heart rate and can be harmful to the heart and blood vessels It can significantly elevate the risk of cardiovascular diseases such as coronary artery disease Circulation

However, other studies may use ultrasound, sample liquid near the lung or require minor incisions to collect larger tissue samples

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It contains nicotine, flavoring, and filler, but no tobacco leaf