Table 3 Hazard ratios for CVD risk based on regular PA, 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

Physical activity

N

Event

Follow-up

duration

Incidence rates

Composite

Subgroup

                                             Adjusted

                                            Adjusted

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

 No steatosis

Irregular

551,331

35,961

3,114,269.7

11.55

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Regular

180,649

9394

1,036,603.8

9.06

0.78 (0.77, 0.80)

0.82 (0.80, 0.84)

0.78 (0.77, 0.80)

0.82 (0.80, 0.84)

 MASLD

Irregular

787,971

47,510

4,472,721.9

10.62

0.92 (0.91, 0.93)

1.16 (1.14, 1.18)

1 (Ref.)

1 (Ref.)

Regular

198,830

10,844

1,136,534.0

9.54

0.83 (0.81, 0.84)

1.01 (0.98, 1.03)

0.90 (0.88, 0.92)

0.87 (0.85, 0.89)

 MetALD

Irregular

95,149

4559

542,349.4

8.41

0.73 (0.71, 0.75)

1.17 (1.13, 1.21)

1 (Ref.)

1 (Ref.)

Regular

24,280

1081

139,387.9

7.76

0.67 (0.63, 0.71)

1.00 (0.94, 1.06)

0.92 (0.86, 0.99)

0.85 (0.80, 0.91)

 ALD

Irregular

65,844

4258

368,725.5

11.55

1.00 (0.97, 1.03)

1.33 (1.28, 1.38)

1 (Ref.)

1 (Ref.)

Regular

17,256

1000

97,692.0

10.24

0.89 (0.83, 0.94)

1.12 (1.05, 1.20)

0.89 (0.83, 0.95)

0.85 (0.79, 0.91)

  p-value

     

< 0.001

< 0.001

–

-

  p for interaction

    

–

–

< 0.001

0.005

Myocardial infarction

 No steatosis

Irregular

551,331

15,423

3,154,108.5

4.89

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Regular

180,649

4186

1,047,198.7

4.00

0.82 (0.79, 0.85)

0.84 (0.81, 0.87)

0.82 (0.79, 0.85)

0.84 (0.81, 0.87)

 MASLD

Irregular

787,971

21,731

4,527,950.5

4.80

0.98 (0.96, 1.00)

1.16 (1.13, 1.19)

1 (Ref.)

1 (Ref.)

Regular

198,830

5000

1,149,083.9

4.35

0.89 (0.86, 0.92)

1.03 (0.99, 1.06)

0.91 (0.88, 0.93)

0.89 (0.86, 0.91)

 MetALD

Irregular

95,149

2058

547,788.5

3.76

0.77 (0.74, 0.81)

1.21 (1.15, 1.28)

1 (Ref.)

1 (Ref.)

Regular

24,280

465

140,741.9

3.30

0.68 (0.62, 0.74)

1.01 (0.91, 1.11)

0.88 (0.80, 0.97)

0.83 (0.75, 0.92)

 ALD

Irregular

65,844

1830

373,671.4

4.90

1.00 (0.96, 1.05)

1.32 (1.24, 1.39)

1 (Ref.)

1 (Ref.)

Regular

17,256

429

98,947.8

4.34

0.89 (0.81, 0.98)

1.12 (1.01, 1.24)

0.88 (0.80, 0.98)

0.85 (0.77, 0.95)

  p-value

     

< 0.001

< 0.001

–

-

  p for interaction

    

–

–

< 0.001

0.161

Ischemic stroke

 No steatosis

Irregular

551,331

18,374

3,146,590.7

5.84

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Regular

180,649

4816

1,045,556.3

4.61

0.79 (0.76, 0.81)

0.83 (0.81, 0.86)

0.79 (0.76, 0.81)

0.83 (0.81, 0.86)

 MASLD

Irregular

787,971

23,992

4,522,191.9

5.31

0.91 (0.89, 0.93)

1.18 (1.15, 1.20)

1 (Ref.)

1 (Ref.)

Regular

198,830

5508

1,148,171.8

4.80

0.82 (0.80, 0.85)

1.03 (0.99, 1.06)

0.90 (0.88, 0.93)

0.87 (0.85, 0.90)

 MetALD

Irregular

95,149

2355

547,080.2

4.30

0.74 (0.71, 0.77)

1.16 (1.11, 1.22)

1 (Ref.)

1 (Ref.)

Regular

24,280

595

140,389.0

4.24

0.73 (0.67, 0.79)

1.05 (0.96, 1.14)

0.98 (0.90, 1.08)

0.90 (0.82, 0.99)

 ALD

Irregular

65,844

2180

372,849.1

5.85

1.00 (0.96, 1.05)

1.29 (1.23, 1.36)

1 (Ref.)

1 (Ref.)

Regular

17,256

528

98,670.2

5.35

0.92 (0.84, 1.00)

1.13 (1.03, 1.24)

0.91 (0.83, 1.01)

0.87 (0.79, 0.96)

  p-value

     

< 0.001

< 0.001

-

–

  p for interaction

    

–

–

< 0.001

0.103

Cardiovascular mortality

 No steatosis

Irregular

551,331

6587

3,189,572.6

2.07

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Regular

180,649

1378

1,056,926.6

1.30

0.63 (0.60, 0.67)

0.72 (0.68, 0.76)

0.63 (0.60, 0.67)

0.72 (0.68, 0.76)

 MASLD

Irregular

787,971

6758

4,581,578.5

1.48

0.72 (0.69, 0.74)

1.16 (1.11, 1.21)

1 (Ref.)

1 (Ref.)

Regular

198,830

1359

1,161,620.3

1.17

0.57 (0.54, 0.60)

0.89 (0.84, 0.95)

0.79 (0.75, 0.84)

0.77 (0.73, 0.82)

 MetALD

Irregular

95,149

560

552,945.9

1.01

0.49 (0.45, 0.54)

1.22 (1.11, 1.35)

1 (Ref.)

1 (Ref.)

Regular

24,280

116

141,821.9

0.82

0.40 (0.33, 0.48)

0.87 (0.72, 1.05)

0.81 (0.66, 0.98)

0.71 (0.58, 0.87)

 ALD

Irregular

65,844

633

378,103.8

1.67

0.81 (0.75, 0.88)

1.55 (1.41, 1.70)

1 (Ref.)

1 (Ref.)

Regular

17,256

128

100,010.7

1.28

0.62 (0.52, 0.74)

1.10 (0.92, 1.32)

0.76 (0.63, 0.92)

0.72 (0.59, 0.86)

  p-value

     

< 0.001

< 0.001

–

-

  p for interaction

    

–

–

< 0.001

0.387

  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, 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; PA, physical activity; SLD, steatotic liver disease.
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