Engaging in physical activity may prevent MACE, death in people with T2D

An inverse association exists between self-reported physical activity (PA) and the risk of major adverse cardiac events (MACE) and all-cause mortality among individuals with type 2 diabetes (T2D) and no previous cardiovascular disease (CVD), suggests a study presented at EASD 2025.

For moderate-to-vigorous PA (MVPA), these associations endure following adjustments for various CVD risk factors, according to the authors led by Dr Line Eriksen, Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark.

“Self-reported PA was an independent predictor of all-cause mortality and MACE in individuals recently diagnosed with T2D and no previous CVD,” Eriksen said. “These associations persisted even after adjustment for classical CVD risk factors.”

Eriksen and her team conducted this prospective cohort study using data from the Danish Centre for Strategic Research in Type 2 Diabetes cohort, including participants from 2010 to 2013 with a diagnosis of T2D within the last 2 years. A total of 11,355 participants self-reported their PA using the Saltin-Grimby Physical Activity Level Scale and were categorized into sedentary, light, and MVPA.

All-cause mortality and MACE, including myocardial infarction, ischaemic stroke, coronary revascularization, heart failure, and CVD death, were the primary outcomes.

Eriksen and colleagues estimated the hazard ratios (HRs) with 95 percent confidence interval (CI) using a parametric survival model with exponential/Gombertz distribution and iterative confounder adjustment. They followed participants until the first occurrence of either MACE, death, emigration, or study end (3 May 2024). Participants with previous CVD (n=1,671) were excluded from the analysis.

Most participants reported engaging in light PA (62.5 percent), and nearly one in five (19.5 percent) engaged in MVPA. On the other hand, 18 percent reported being sedentary. Overall, 1,149 CVD events and 1,048 deaths occurred during a median follow-up of 8.4 years. Higher PA levels showed an inverse association with both MACE and all-cause mortality. [EASD 2025, abstract 6]

Risk reduction

After adjusting for age, sex, year of study enrolment, T2D duration, smoking, alcohol consumption, and waist circumference, participants who reported engaging in light PA had a 21-percent lower risk of MACE, while those who engaged in MVPA had a 29-percent risk reduction compared with sedentary individuals. All-cause mortality risk also decreased by 27 percent and 35 percent, respectively.

“This association was primarily driven by coronary revascularization, heart failure, and CVD death,” Eriksen said.

The HRs for MVPA remained significant for both MACE (HR, 0.68, 95 percent CI, 0.51‒0.92) and all-cause mortality (HR, 0.67, 95 percent CI, 0.47‒0.96) following adjustments for CVD risk factors, such as low-density lipoprotein, glycated haemoglobin, systolic blood pressure, estimated glomerular filtration rate, and urine albumin‒creatinine ratio.

However, the associations for light PA weakened, showing no observable difference in risk relative to sedentary participants.

“Even light activity reduces the risk of serious cardiac events and all-cause mortality, independently of classical CVD risk factors,” Eriksen said. “This highlights the potential health benefits of doing at least some PA instead of doing none in terms of preventing CVD and premature deaths for individuals recently diagnosed with T2D."