Table 4.
Hazard ratios for CVD risk based on regular PA and smoking status, stratified by steatotic liver disease group.
| 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 | |||||||||
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.
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.
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.
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.