Physical Activity and Cardiovascular Risk in Type 2 Diabetes With Normal Body Mass Index and Abdominal Obesity: A Nationwide Cohort Study.

Background

The prognostic implications of abdominal obesity and moderate-to-vigorous physical activity (MVPA) in patients with type 2 diabetes who have a normal body mass index remain unclear.

Methods

This nationwide retrospective cohort study included 323 029 adults with newly diagnosed type 2 diabetes and a normal body mass index (<23 kg/m2) between January 1, 2010, and December 31, 2023, from the Korean National Health Insurance Service database. Abdominal obesity was defined using sex-specific waist circumference thresholds (≥90 cm for men, ≥80 cm for women). MVPA was assessed through standardized self-reported questionnaires administered during routine health screenings. The primary outcome was major adverse cardiovascular and cerebrovascular events, defined as a composite of all-cause death, myocardial infarction, ischemic stroke, or hospitalization for heart failure.

Results

Among the study population, 34 033 (10.5%) had abdominal obesity. During a median follow-up of 6.0 years (interquartile range, 2.6-9.0 years), abdominal obesity was associated with a higher risk of major adverse cardiovascular and cerebrovascular events (adjusted hazard ratio [HR], 1.13 [95% CI, 1.09-1.17]). Among patients with abdominal obesity, regular MVPA after diagnosis (27.1%) was associated with a significantly lower risk of major adverse cardiovascular and cerebrovascular events (adjusted HR 0.74 [95% CI, 0.68-0.80]), all-cause mortality (adjusted HR 0.72 [95% CI, 0.65-0.80]), ischemic stroke (adjusted HR 0.77 [95% CI, 0.66-0.89]), and hospitalization for heart failure (adjusted HR 0.75 [95% CI, 0.60-0.93]). The cardiovascular protective effects of MVPA were consistent regardless of statin or antidiabetic medication use.

Conclusions

In patients with type 2 diabetes and a normal body mass index, abdominal obesity was independently associated with a higher risk of major adverse cardiovascular and cerebrovascular events. Regular engagement in MVPA showed consistent cardiovascular benefits in this population, irrespective of pharmacotherapy. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT07071545.