Physical Activity and Cardiovascular Risk in Type 2 Diabetes With Normal Body Mass Index and Abdominal Obesity: A Nationwide Cohort Study
4 affiliations
- 1Korea University Anam Hospital
- 2Sungkyunkwan University School of Medicine
- 3Sungkyunkwan University
- 4Jeonbuk National University Medical School
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.
Related
- Association of physical activity with all-cause, cardiovascular, and cancer mortality among adults with diabetes: Mexico City Prospective Study
- Continuous glucose monitoring use is associated with higher physical activity in adults with type 1 diabetes: a nationwide cross-sectional study
- Sex and Socioeconomic Differences in the Initiation of SGLT2 Inhibitors and GLP‐1 Receptor Agonists in Patients With Type 2 Diabetes and Cardiovascular Disease: A Nationwide Cohort Study
- Trajectories of leisure-time physical activity behavior and risk of incident cardiovascular disease in middle-aged and older adults
- Type 2 diabetes, cardiovascular disease and chronic kidney disease in Hungary: multimorbidity and 11-year survival in a nationwide retrospective study
BibTeX
@article{kim2026physical,
title = {{Physical Activity and Cardiovascular Risk in Type 2 Diabetes With Normal Body Mass Index and Abdominal Obesity: A Nationwide Cohort Study}},
author = {Onyou Kim and Yong Hwan Park and Soo Yeon Kim and Myeongcheol Lee and Wonchang Hahn and Chang Hoon Kim and Danbee Kang and Ki Hong Choi},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.126.052821},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.126.052821},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Physical Activity and Cardiovascular Risk in Type 2 Diabetes With Normal Body Mass Index and Abdominal Obesity: A Nationwide Cohort Study
AU - Onyou Kim
AU - Yong Hwan Park
AU - Soo Yeon Kim
AU - Myeongcheol Lee
AU - Wonchang Hahn
AU - Chang Hoon Kim
AU - Danbee Kang
AU - Ki Hong Choi
PY - 2026
DA - 2026/10/23
JO - Journal of the American Heart Association
DO - 10.1161/jaha.126.052821
UR - https://www.ahajournals.org/doi/10.1161/JAHA.126.052821
AB - 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.
SN - 2047-9980
ER -