Association Between Moderate‐to‐Vigorous Physical Activity and the Risk of Major Adverse Cardiovascular Events or Mortality in People With Various Metabolic Syndrome Status: A Nationwide Population‐Based Cohort Study Including 6 Million People

BACKGROUND: A population‐scale evidence for the association between moderate‐to‐vigorous physical activity (MV‐PA) and risks of major adverse cardiovascular event (MACE) or all‐cause mortality in people with various metabolic syndrome (MetS) status is warranted. METHODS AND RESULTS: We performed a nationwide retrospective cohort study based on the claims database of South Korea. We included people who received ≥3 national health screenings from 2009 to 2013 without a previous MACE history. We determined the MetS status of 6 108 077 people: MetS‐chronic (N=864 063), MetS‐developed (N=348 163), MetS‐recovery (N=348 313), and MetS‐free (N=4 547 538). The exposure was self‐reported MV‐PA frequencies. The outcome was incident MACEs or all‐cause mortality. The incidence rate ratios (IRR) were calculated with adjustments for clinical/demographic characteristics. During the median follow‐up of 4.28 years, 78 770 and 51 840 people experienced MACEs or died, respectively. Those who engaged in MV‐PA had a significantly lower risk of MACEs or all‐cause mortality than those not engaged in MV‐PA in every spectrum of MetS. Even among those who were free from MetS (for MACEs, IRR 0.94 [0.92–0.97], for all‐cause mortality, IRR 0.85 [0.82–0.87]) or who had already recovered from MetS (for MACEs, IRR 0.89 [0.84–0.95], for all‐cause mortality, IRR 0.74 [0.68–0.81]), 1 to 2 days per week of MV‐PA were significantly associated with lower risk of the adverse outcomes when compared with not being engaged in MV‐PA. Those who were engaged in MV‐PA more frequently also had significantly lower risks of MACEs or all‐cause mortality. CONCLUSIONS: This nationwide study suggests that MV‐PA may be recommended to the general population regardless of recent MetS status.