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Unlike its additive effect with diabetes on MASH-fibrosis, smoking exhibits a synergistic effect with other metabolic risk factors, such as hypertension and dyslipidemia, on the development of CVD [72,73,74]

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Nationally, the smokeless tobacco use prevalence among high school students was 3.1%.2 In 2021, 3.6% of high school students in Pennsylvania smoked cigars, cigarillos or little cigars on at least one day in the past 30 days