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

Year: 2026

Type: article

Abstract: 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: ) 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.

Source: Journal of the American Heart Association

DOI: 10.1161/jaha.126.052821