Table 2.
Hazard ratios for CVD risk based on smoking status, stratified by steatotic liver disease group.
| 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 | ||||||||
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.
Incidence rates are presented per 1000 person-years.
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.
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.