Table 2 Hazard ratios for CVD risk based on smoking status, stratified by steatotic liver disease group.

From: Impact of smoking and physical activity on cardiovascular outcomes in type 2 diabetes across steatotic liver disease categories

SLD group

Smoking

N

Event

Follow-up

duration

Incidence rates

Composite

Subgroup

                                                  Adjusted

                                               Adjusted

Composite CVD event (myocardial infarction or ischemic stroke or cardiovascular mortality)

 No Steatosis

Never

480,981

28,984

2,740,453.6

10.58

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Former

129,939

7841

735,691.4

10.66

1.01 (0.98, 1.03)

0.97 (0.94, 0.99)

1.01 (0.98, 1.03)

0.97 (0.94, 0.99)

Current

121,060

8530

674,728.4

12.64

1.20 (1.17, 1.23)

1.60 (1.56, 1.64)

1.20 (1.17, 1.23)

1.60 (1.56, 1.64)

 MASLD

Never

503,517

31,266

2,863,373.0

10.92

1.03 (1.02, 1.05)

1.20 (1.18, 1.22)

1 (Ref.)

1 (Ref.)

Former

232,604

12,528

1,327,851.5

9.43

0.89 (0.88, 0.91)

1.12 (1.09, 1.15)

0.86 (0.85, 0.88)

0.93 (0.91, 0.95)

Current

250,680

14,560

1,418,031.4

10.27

0.97 (0.96, 0.99)

1.80 (1.76, 1.84)

0.94 (0.92, 0.96)

1.50 (1.47, 1.53)

 MetALD

Never

21,582

1087

123,356.0

8.81

0.83 (0.79, 0.89)

1.28 (1.20, 1.36)

1 (Ref.)

1 (Ref.)

Former

40,167

1667

231,288.3

7.21

0.68 (0.65, 0.72)

1.12 (1.06, 1.18)

0.82 (0.76, 0.88)

0.88 (0.81, 0.95)

Current

57,680

2886

327,093.1

8.82

0.84 (0.81, 0.87)

1.80 (1.73, 1.89)

1.00 (0.94, 1.08)

1.41 (1.32, 1.51)

 ALD

Never

21,064

1403

118,593.4

11.83

1.12 (1.06, 1.18)

1.32 (1.25, 1.40)

1 (Ref.)

1 (Ref.)

Former

25,857

1396

147,165.5

9.49

0.90 (0.85, 0.95)

1.26 (1.19, 1.34)

0.80 (0.74, 0.86)

0.95 (0.89, 1.03)

Current

36,179

2459

200,658.6

12.25

1.16 (1.12, 1.21)

2.14 (2.04, 2.24)

1.04 (0.97, 1.11)

1.61 (1.51, 1.73)

 p-value

     

< 0.001

< 0.001

–

–

 p for interaction

    

–

–

< 0.001

< 0.001

Myocardial infarction

 No steatosis

Never

480,981

12,464

2,772,805.6

4.50

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Former

129,939

3430

743,875.8

4.61

1.03 (0.99, 1.07)

1.01 (0.97, 1.05)

1.03 (0.99, 1.07)

1.01 (0.97, 1.05)

Current

121,060

3715

684,625.8

5.43

1.21 (1.17, 1.26)

1.56 (1.50, 1.63)

1.21 (1.17, 1.26)

1.56 (1.50, 1.63)

 MASLD

Never

503,517

13,895

2,900,464.6

4.79

1.07 (1.04, 1.09)

1.19 (1.15, 1.22)

1 (Ref.)

1 (Ref.)

Former

232,604

5775

1,341,912.7

4.30

0.96 (0.93, 0.99)

1.16 (1.11, 1.20)

0.90 (0.87, 0.93)

0.98 (0.94, 1.01)

Current

250,680

7061

1,434,657.1

4.92

1.10 (1.07, 1.13)

1.81 (1.74, 1.88)

1.03 (1.00, 1.06)

1.53 (1.48, 1.58)

 MetALD

Never

21,582

481

124,699.4

3.86

0.86 (0.79, 0.94)

1.37 (1.25, 1.51)

1 (Ref.)

1 (Ref.)

Former

40,167

727

233,310.4

3.12

0.70 (0.65, 0.75)

1.17 (1.08, 1.27)

0.81 (0.72, 0.91)

0.85 (0.76, 0.95)

Current

57,680

1315

330,520.6

3.98

0.89 (0.84, 0.94)

1.84 (1.72, 1.97)

1.03 (0.93, 1.15)

1.34 (1.21, 1.49)

 ALD

Never

21,064

573

120,329.7

4.76

1.06 (0.98, 1.15)

1.26 (1.16, 1.37)

1 (Ref.)

1 (Ref.)

Former

25,857

601

148,836.8

4.04

0.90 (0.83, 0.98)

1.30 (1.19, 1.42)

0.85 (0.76, 0.95)

1.03 (0.92, 1.15)

Current

36,179

1085

203,452.6

5.33

1.19 (1.12, 1.27)

2.14 (1.99, 2.30)

1.12 (1.02, 1.24)

1.70 (1.53, 1.88)

 p-value

     

< 0.001

< 0.001

–

–

 p for interaction

    

–

–

< 0.001

0.028

Ischemic stroke

 No steatosis

Never

480,981

14,825

2,766,634.4

5.36

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Former

129,939

3948

742,712.3

5.32

0.99 (0.96, 1.03)

0.94 (0.91, 0.98)

0.99 (0.96, 1.03)

0.94 (0.91, 0.98)

Current

121,060

4417

682,800.3

6.47

1.21 (1.17, 1.25)

1.63 (1.57, 1.69)

1.21 (1.17, 1.25)

1.63 (1.57, 1.69)

 MASLD

Never

503,517

16,234

2,894,419.1

5.61

1.05 (1.03, 1.07)

1.23 (1.20, 1.26)

1 (Ref.)

1 (Ref.)

Former

232,604

6271

1,341,052.4

4.68

0.87 (0.85, 0.90)

1.11 (1.07, 1.15)

0.83 (0.81, 0.86)

0.90 (0.87, 0.93)

Current

250,680

6995

1,434,892.1

4.87

0.91 (0.89, 0.94)

1.76 (1.70, 1.82)

0.87 (0.85, 0.90)

1.43 (1.38, 1.47)

 MetALD

Never

21,582

571

124,432.6

4.59

0.86 (0.79, 0.93)

1.24 (1.14, 1.36)

1 (Ref.)

1 (Ref.)

Former

40,167

894

232,894.9

3.84

0.72 (0.67, 0.77)

1.13 (1.05, 1.21)

0.84 (0.75, 0.93)

0.91 (0.82, 1.01)

Current

57,680

1485

330,141.7

4.50

0.84 (0.80, 0.89)

1.78 (1.67, 1.89)

0.98 (0.89, 1.08)

1.43 (1.30, 1.58)

 ALD

Never

21,064

773

119,858.2

6.45

1.21 (1.12, 1.30)

1.38 (1.28, 1.49)

1 (Ref.)

1 (Ref.)

Former

25,857

715

148,482.2

4.82

0.90 (0.83, 0.97)

1.20 (1.11, 1.31)

0.75 (0.67, 0.83)

0.87 (0.79, 0.97)

Current

36,179

1220

203,178.9

6.00

1.12 (1.06, 1.19)

1.99 (1.86, 2.13)

0.93 (0.85, 1.02)

1.44 (1.31, 1.58)

 p-value

     

< 0.001

< 0.001

–

–

 p for interaction

    

–

–

< 0.001

< 0.001

Cardiovascular mortality

 No steatosis

Never

480,981

5164

2,801,538.0

1.84

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Former

129,939

1386

751,520.4

1.84

1.00 (0.94, 1.06)

0.94 (0.88, 1.00)

1.00 (0.94, 1.06)

0.94 (0.88, 1.00)

Current

121,060

1415

693,440.9

2.04

1.12 (1.05, 1.18)

1.78 (1.67, 1.90)

1.12 (1.05, 1.18)

1.78 (1.67, 1.90)

 MASLD

Never

503,517

4583

2,934,332.4

1.56

0.85 (0.82, 0.88)

1.20 (1.14, 1.25)

1 (Ref.)

1 (Ref.)

Former

232,604

1679

1,356,071.3

1.24

0.67 (0.64, 0.71)

1.05 (0.98, 1.12)

0.79 (0.75, 0.84)

0.87 (0.82, 0.93)

Current

250,680

1855

1,452,795.0

1.28

0.70 (0.66, 0.74)

2.08 (1.95, 2.22)

0.82 (0.78, 0.87)

1.74 (1.64, 1.85)

 MetALD

Never

21,582

141

125,890.9

1.12

0.61 (0.52, 0.72)

1.26 (1.05, 1.50)

1 (Ref.)

1 (Ref.)

Former

40,167

192

235,026.7

0.82

0.44 (0.39, 0.51)

1.10 (0.94, 1.29)

0.73 (0.59, 0.91)

0.88 (0.70, 1.09)

Current

57,680

343

333,850.2

1.03

0.56 (0.50, 0.63)

2.19 (1.94, 2.48)

0.92 (0.76, 1.12)

1.74 (1.43, 2.12)

 ALD

Never

21,064

212

121,716.7

1.74

0.95 (0.83, 1.09)

1.42 (1.23, 1.64)

1 (Ref.)

1 (Ref.)

Former

25,857

200

150,265.5

1.33

0.72 (0.63, 0.83)

1.44 (1.24, 1.68)

0.76 (0.63, 0.93)

1.02 (0.84, 1.24)

Current

36,179

349

206,132.2

1.69

0.93 (0.83, 1.03)

2.91 (2.57, 3.30)

0.98 (0.83, 1.16)

2.05 (1.73, 2.44)

 p-value

     

< 0.001

< 0.001

–

–

 p for interaction

    

–

–

< 0.001

0.433

  1. The results were obtained using Cox proportional hazards analysis and presented as HR with 95% CI. The follow-up duration is presented as person-years.
  2. Incidence rates are presented per 1000 person-years.
  3. Adjusted model: Adjusted for age, sex, income, regular physical activity, CCI score, fasting glucose level, DM duration, insulin use, OHA use, CKD, BMI, alcohol consumption, HTN, and dyslipidemia.
  4. ALD, alcohol-related liver disease; BMI, body mass index; CCI, Charlson Comorbidity Index; CI, confidence interval; CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus; HR, hazard ratio; HTN, hypertension; MASLD, metabolic dysfunction-associated steatotic liver disease; MetALD, metabolic dysfunction and alcohol-related steatotic liver disease; OHA, oral hypoglycemic agent; SLD, steatotic liver disease.
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