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th substance use were significant (p-interaction 0.05), with recreational substance use and premature ASCVD showing stronger associations among women than in men with premature ASCVD. All subgroups of recreational substances were independently associated with a higher likelihood of premature and extremely premature ASCVD. Recreational substance use confers a greater magnitude of risk for premature ASCVD among women. A graded response relationship exists between increasing number of recreational substances used and higher likelihood of early-onse

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