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

About one in ten adults with newly diagnosed type 2 diabetes and a normal BMI had abdominal obesity.

• The cohort included 323,029 adults with newly diagnosed type 2 diabetes and BMI <23 kg/m2 from the Korean National Health Insurance Service database (2010-2023).
• 34,033 (10.5%) had abdominal obesity.
• Abdominal obesity was defined as waist circumference ≥90 cm for men and ≥80 cm for women.

Abdominal obesity was independently associated with a higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) in patients with type 2 diabetes and normal BMI.

• Adjusted HR 1.13 (95% CI, 1.09-1.17).
• MACCE was a composite of all-cause death, myocardial infarction, ischemic stroke, or hospitalization for heart failure.
• Median follow-up was 6.0 years (interquartile range, 2.6-9.0 years).

Among patients with abdominal obesity, regular MVPA after diagnosis was associated with a significantly lower risk of MACCE.

• 27.1% of patients with abdominal obesity engaged in regular MVPA after diagnosis.
• Adjusted HR 0.74 (95% CI, 0.68-0.80) for MACCE.
• MVPA was assessed by standardized self-reported questionnaires administered during routine health screenings.

In patients with abdominal obesity, regular MVPA was associated with lower all-cause mortality.

• Adjusted HR 0.72 (95% CI, 0.65-0.80).

In patients with abdominal obesity, regular MVPA was associated with lower risk of ischemic stroke and heart failure hospitalization.

• Ischemic stroke: adjusted HR 0.77 (95% CI, 0.66-0.89).
• Hospitalization for heart failure: adjusted HR 0.75 (95% CI, 0.60-0.93).

The cardiovascular protective association of MVPA was consistent regardless of statin or antidiabetic medication use.

• Consistency was observed across subgroups defined by statin and antidiabetic medication use.
• The authors conclude MVPA benefits were seen irrespective of pharmacotherapy.