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Furthermore, it was reported that short-term hookah use (both tobacco-based and tobacco-free products) disrupts the autonomic nervous system regulation on the cardiac cycle, thereby causing a reduction in HRvariability, whichin turnmight aggravate the risk of coronary artery disease development [18]

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Moreover, some studies reported low response rates to mailed questionnaires, others enrolled fewer controls than cases, and some included a heterogeneous clinical case mix