Effects of moderate to vigorous physical activity on the associations of insulin resistance surrogate with incident cardiovascular disease and all-cause mortality: a cohort study from the UK Biobank

Ying Zhu¹Tianci Yao²Hongyu Yan¹Qinmei Ke^1*

• ¹Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
• ²Yueyang Central Hospital Department of Endocrinology, Yueyang, China

Background Moderate to vigorous physical activity (MVPA) and insulin resistance (IR) are associated with cardiovascular disease (CVD). It remains unclear whether different durations of MVPA can modify the associations of triglyceride glucose-waist height ratio (TyG-WHtR) index, a surrogate for IR, with incident CVD and all-cause mortality, and particularly whether MVPA levels beyond guideline recommendations can provide additional benefit. Methods This cohort study included 299,928 adults from UK Biobank study who were free of prevalent CVD at baseline and had complete data on MVPA, the TyG-WHtR index, and covariates. Cox proportional hazards model was used to assess the independent and joint associations of MVPA and TyG-WHtR with incident CVD and all-cause mortality. A product term of MVPA (<150, 150-299, 300-599, and ≥600 min/wk) and TyG-WHtR (tertiles) was included in the model to assess the multiplicative interaction. Results During a median follow-up of 13.8 and 13.6 years, 27,342 CVD cases and 21,258 deaths were observed. MVPA demonstrated a reverse J-shaped association with incident CVD, with a cut-off point at 261.71 min/wk, whereas an L-shaped association was observed for all-cause mortality with risk reduction plateauing at 217.00 min/wk. Elevated TyG-WHtR showed positive associations with increased risks of incident CVD and all-cause mortality. No significant interaction was found on incident CVD, whereas interaction effect was observed between 150-299 min/wk MVPA and TyG-WHtR tertile 2 on all-cause mortality (HR for interaction, 0.89; 95%CI, 0.81-0.97; P for interaction=0.012). Compared to the reference group (<150 min/wk MVPA and TyG-WHtR tertile 3), all other combined groups were associated with lower risks. Among participants with MVPA levels of 150-299, 300-599 and ≥600 min/wk, the extent of risk reduction for the outcomes was similar. Conclusions Our findings highlight the importance of engaging in guideline-recommended MVPA (150-299 min/wk) to reduce all-cause mortality risk, particularly among individuals with moderate IR (TyG-WHtR 7.01-8.03), who are more susceptible to its benefits. Furthermore, the protective effects of higher levels of MVPA against IR-related risks were consistent with those of guideline-recommended MVPA.