Table 4 Hazard ratios for CVD risk based on regular PA and 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

Group

N

Event

Follow-up duration

Incidence rates

Composite

Subgroup

                                              Adjusted

                                             Adjusted

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

 No steatosis

Group 1

155,140

7735

893,072.6

8.66

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Group 2

455,780

29,090

2,583,072.4

11.26

1.30 (1.27, 1.34)

1.23 (1.20, 1.26)

1.30 (1.27, 1.34)

1.23 (1.20, 1.26)

Group 3

25,509

1659

143,531.2

11.56

1.34 (1.27, 1.41)

1.71 (1.63, 1.81)

1.34 (1.27, 1.41)

1.71 (1.63, 1.81)

Group 4

95,551

6871

531,197.3

12.93

1.50 (1.45, 1.55)

1.99 (1.92, 2.05)

1.50 (1.45, 1.55)

1.99 (1.92, 2.05)

 MASLD

Group 1

154,380

8286

884,086.8

9.37

1.08 (1.05, 1.12)

1.24 (1.20, 1.28)

1 (Ref.)

1 (Ref.)

Group 2

581,741

35,508

3,307,137.7

10.74

1.24 (1.21, 1.27)

1.45 (1.41, 1.48)

1.15 (1.12, 1.17)

1.17 (1.14, 1.20)

Group 3

44,450

2558

252,447.2

10.13

1.17 (1.12, 1.23)

2.01 (1.92, 2.10)

1.08 (1.04, 1.13)

1.62 (1.55, 1.70)

Group 4

206,230

12,002

1,165,584.3

10.30

1.19 (1.16, 1.23)

2.22 (2.15, 2.29)

1.10 (1.07, 1.13)

1.79 (1.74, 1.85)

 MetALD

Group 1

14,686

624

84,786.6

7.36

0.85 (0.79, 0.92)

1.24 (1.14, 1.35)

1 (Ref.)

1 (Ref.)

Group 2

47,063

2,130

269,857.6

7.89

0.91 (0.87, 0.96)

1.47 (1.40, 1.55)

1.07 (0.98, 1.17)

1.19 (1.09, 1.30)

Group 3

9594

457

54,601.4

8.37

0.97 (0.88, 1.07)

1.92 (1.75, 2.12)

1.14 (1.01, 1.29)

1.55 (1.37, 1.75)

Group 4

48,086

2,429

272,491.8

8.91

1.03 (0.99, 1.08)

2.25 (2.15, 2.37)

1.21 (1.11, 1.33)

1.82 (1.66, 1.98)

 ALD

Group 1

11,016

595

62,832.2

9.47

1.09 (1.01, 1.19)

1.35 (1.24, 1.47)

1 (Ref.)

1 (Ref.)

Group 2

35,905

2204

202,926.6

10.86

1.26 (1.20, 1.32)

1.61 (1.54, 1.70)

1.15 (1.05, 1.26)

1.19 (1.09, 1.31)

Group 3

6240

405

34,859.8

11.62

1.35 (1.22, 1.49)

2.29 (2.07, 2.54)

1.23 (1.08, 1.40)

1.70 (1.50, 1.93)

Group 4

29,939

2054

165,798.9

12.39

1.44 (1.37, 1.51)

2.67 (2.53, 2.82)

1.31 (1.20, 1.44)

1.97 (1.80, 2.16)

  p-value

     

< 0.001

< 0.001

–

–

  p for interaction

    

–

–

< 0.001

0.002

Myocardial infarction

 No steatosis

Group 1

155,140

3,467

901,764.2

3.84

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Group 2

455,780

12,427

2,614,917.2

4.75

1.24 (1.19, 1.29)

1.19 (1.15, 1.24)

1.24 (1.19, 1.29)

1.19 (1.15, 1.24)

Group 3

25,509

719

145,434.5

4.94

1.29 (1.19, 1.40)

1.60 (1.48, 1.73)

1.29 (1.19, 1.40)

1.60 (1.48, 1.73)

Group 4

95,551

2996

539,191.4

5.56

1.45 (1.38, 1.52)

1.86 (1.77, 1.95)

1.45 (1.38, 1.52)

1.86 (1.77, 1.95)

 MASLD

Group 1

154,380

3781

893,727.7

4.23

1.10 (1.05, 1.15)

1.22 (1.16, 1.28)

1 (Ref.)

1 (Ref.)

Group 2

581,741

15,889

3,348,649.6

4.74

1.24 (1.19, 1.28)

1.39 (1.34, 1.44)

1.12 (1.08, 1.16)

1.14 (1.10, 1.18)

Group 3

44,450

1219

255,356.2

4.77

1.25 (1.17, 1.33)

1.93 (1.80, 2.06)

1.13 (1.06, 1.21)

1.58 (1.48, 1.69)

Group 4

206,230

5842

1,179,300.9

4.95

1.29 (1.24, 1.35)

2.13 (2.03, 2.22)

1.18 (1.13, 1.22)

1.75 (1.67, 1.82)

 MetALD

Group 1

14,686

251

85,594.6

2.93

0.77 (0.67, 0.87)

1.16 (1.02, 1.32)

1 (Ref.)

1 (Ref.)

Group 2

47,063

957

272,415.2

3.51

0.92 (0.85, 0.98)

1.51 (1.40, 1.63)

1.20 (1.04, 1.37)

1.30 (1.13, 1.50)

Group 3

9594

214

55,147.4

3.88

1.01 (0.88, 1.16)

1.96 (1.70, 2.26)

1.32 (1.10, 1.59)

1.69 (1.41, 2.03)

Group 4

48,086

1101

275,373.2

4.00

1.05 (0.98, 1.12)

2.17 (2.01, 2.34)

1.36 (1.19, 1.56)

1.87 (1.63, 2.15)

 ALD

Group 1

11,016

249

63,569.6

3.92

1.02 (0.90, 1.16)

1.28 (1.13, 1.46)

1 (Ref.)

1 (Ref.)

Group 2

35,905

925

205,597.0

4.50

1.17 (1.09, 1.26)

1.52 (1.41, 1.64)

1.15 (1.00, 1.32)

1.19 (1.03, 1.36)

Group 3

6240

180

35,378.3

5.09

1.33 (1.14, 1.54)

2.21 (1.90, 2.58)

1.30 (1.08, 1.58)

1.72 (1.42, 2.09)

Group 4

29,939

905

168,074.4

5.38

1.41 (1.31, 1.51)

2.53 (2.34, 2.75)

1.38 (1.20, 1.59)

1.98 (1.72, 2.27)

  p-value

     

< 0.001

< 0.001

–

–

  p for interaction

    

–

–

< 0.001

0.237

Ischemic stroke

 No steatosis

Group 1

155,140

3961

900,436.8

4.40

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Group 2

455,780

14,812

2,608,910.0

5.68

1.29 (1.25, 1.34)

1.21 (1.17, 1.25)

1.29 (1.25, 1.34)

1.21 (1.17, 1.25)

Group 3

25,509

855

145,119.6

5.89

1.34 (1.25, 1.45)

1.74 (1.61, 1.87)

1.34 (1.25, 1.45)

1.74 (1.61, 1.87)

Group 4

95,551

3562

537,680.7

6.62

1.51 (1.45, 1.58)

2.02 (1.93, 2.11)

1.51 (1.45, 1.58)

2.02 (1.93, 2.11)

 MASLD

Group 1

154,380

4265

892,801.3

4.78

1.09 (1.04, 1.14)

1.25 (1.20, 1.31)

1 (Ref.)

1 (Ref.)

Group 2

581,741

18,240

3,342,670.3

5.46

1.24 (1.20, 1.29)

1.46 (1.40, 1.51)

1.14 (1.11, 1.18)

1.16 (1.13, 1.20)

Group 3

44,450

1243

255,370.5

4.87

1.11 (1.04, 1.18)

1.97 (1.84, 2.10)

1.02 (0.96, 1.09)

1.57 (1.47, 1.67)

Group 4

206,230

5752

1,179,521.7

4.88

1.11 (1.07, 1.16)

2.16 (2.07, 2.25)

1.02 (0.98, 1.07)

1.72 (1.66, 1.79)

 MetALD

Group 1

14,686

358

85,283.8

4.20

0.96 (0.86, 1.06)

1.33 (1.19, 1.48)

1 (Ref.)

1 (Ref.)

Group 2

47,063

1107

272,043.8

4.07

0.93 (0.87, 0.99)

1.43 (1.33, 1.53)

0.97 (0.86, 1.09)

1.08 (0.96, 1.21)

Group 3

9594

237

55,105.2

4.30

0.98 (0.86, 1.12)

1.90 (1.66, 2.17)

1.03 (0.87, 1.21)

1.43 (1.22, 1.69)

Group 4

48,086

1248

275,036.5

4.54

1.04 (0.97, 1.10)

2.22 (2.07, 2.38)

1.08 (0.96, 1.22)

1.67 (1.49, 1.88)

 ALD

Group 1

11,016

321

63,423.3

5.06

1.15 (1.03, 1.29)

1.37 (1.22, 1.54)

1 (Ref.)

1 (Ref.)

Group 2

35,905

1167

204,917.1

5.69

1.30 (1.21, 1.38)

1.60 (1.50, 1.72)

1.13 (1.00, 1.27)

1.17 (1.04, 1.33)

Group 3

6240

207

35,246.9

5.87

1.34 (1.16, 1.54)

2.21 (1.92, 2.55)

1.16 (0.98, 1.39)

1.62 (1.36, 1.93)

Group 4

29,939

1013

167,932.0

6.03

1.38 (1.29, 1.48)

2.47 (2.29, 2.66)

1.20 (1.06, 1.36)

1.80 (1.59, 2.05)

  p-value

     

< 0.001

< 0.001

–

–

  p for interaction

    

–

–

< 0.001

< 0.001

Cardiovascular mortality

 No steatosis

Group 1

155,140

1108

909,786.7

1.22

1 (Ref.)

1 (Ref.)

1 (Ref.)

1 (Ref.)

Group 2

455,780

5442

2,643,271.6

2.06

1.69 (1.59, 1.81)

1.45 (1.36, 1.55)

1.69 (1.59, 1.81)

1.45 (1.36, 1.55)

Group 3

25,509

270

147,139.9

1.83

1.52 (1.33, 1.73)

2.21 (1.93, 2.52)

1.52 (1.33, 1.73)

2.21 (1.93, 2.52)

Group 4

95,551

1145

546,301.0

2.10

1.74 (1.60, 1.89)

2.57 (2.37, 2.80)

1.74 (1.60, 1.89)

2.57 (2.37, 2.80)

 MASLD

Group 1

154,380

1034

903,132.6

1.14

0.94 (0.87, 1.03)

1.25 (1.14, 1.36)

1 (Ref.)

1 (Ref.)

Group 2

581,741

5228

3,387,271.2

1.54

1.27 (1.19, 1.36)

1.68 (1.57, 1.80)

1.35 (1.26, 1.44)

1.35 (1.26, 1.44)

Group 3

44,450

325

258,487.7

1.26

1.04 (0.92, 1.18)

2.59 (2.28, 2.94)

1.10 (0.97, 1.25)

2.08 (1.83, 2.36)

Group 4

206,230

1530

1,194,307.3

1.28

1.06 (0.98, 1.15)

3.01 (2.77, 3.26)

1.13 (1.04, 1.22)

2.42 (2.23, 2.62)

 MetALD

Group 1

14,686

67

86,132.5

0.78

0.64 (0.50, 0.82)

1.23 (0.95, 1.58)

1 (Ref.)

1 (Ref.)

Group 2

47,063

266

274,785.2

0.97

0.80 (0.70, 0.91)

1.75 (1.51, 2.02)

1.25 (0.95, 1.63)

1.42 (1.09, 1.86)

Group 3

9594

49

55,689.4

0.88

0.73 (0.55, 0.97)

2.35 (1.75, 3.14)

1.14 (0.79, 1.64)

1.91 (1.32, 2.76)

Group 4

48,086

294

278,160.7

1.06

0.88 (0.77, 1.00)

3.29 (2.86, 3.78)

1.37 (1.05, 1.78)

2.68 (2.05, 3.49)

 ALD

Group 1

11,016

77

64,206.5

1.20

0.99 (0.78, 1.24)

1.52 (1.21, 1.93)

1 (Ref.)

1 (Ref.)

Group 2

35,905

335

207,775.8

1.61

1.33 (1.17, 1.50)

2.13 (1.88, 2.43)

1.35 (1.05, 1.72)

1.40 (1.09, 1.79)

Group 3

6240

51

35,804.2

1.42

1.18 (0.89, 1.56)

3.13 (2.36, 4.17)

1.19 (0.84, 1.70)

2.06 (1.44, 2.93)

Group 4

29,939

298

170,328.0

1.75

1.45 (1.28, 1.65)

4.36 (3.79, 5.01)

1.47 (1.14, 1.89)

2.86 (2.22, 3.68)

  p-value

     

< 0.001

< 0.001

–

–

  p for interaction

    

–

–

< 0.001

0.639

  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. Group 1: never smoker or former smoker with regular PA; Group 2: never smoker or former smoker without regular PA; Group 3: current smoker with regular PA; Group 4: current smoker without regular PA.
  4. 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.
  5. 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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