Smoking significantly exacerbates this risk, with recent evidence showing that cigarette smoking is associated with a 22% increased risk of CVD events in MASLD patients compared to non-smokers (aHR 1.22, 95% CI 1.151.30) [71]
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Second, smoking habits were self-reported through questionnaires rather than confirmed through biochemical methods, such as urine cotinine levels, which may lead to recall, misclassification, and measurement errors
The cigarettes had traditionally been distributed as tokens of appreciation to individuals who assisted during imperial visits and other imperial activities, but were to be replaced by confectionery and other gifts in response to changing attitudes toward smoking
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