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Physical activity (PA) reduces CVD morbidity and mortality. We aimed to determine the relationship between the composition of moderate\u2010to\u2010vigorous PA (MVPA), light PA (LPA), sedentary behavior (SB), and sleep during midlife to the incidence of major adverse cardiac events (MACE) and all\u2010cause mortality at a 7\u2010year follow\u2010up. The study population consisted of Northern Finland Birth Cohort 1966 members who participated in the 46\u2010year follow\u2010up in 2012 and were free of MACE (<jats:italic>N<\/jats:italic>\u00a0=\u20094147). Time spent in MVPA, LPA, and SB was determined from accelerometer data. Sleep time was self\u2010reported. Hospital visits and deaths were obtained from national registers. Participants were followed until December 31, 2019, or first MACE occurrence (acute myocardial infarction, unstable angina pectoris, stroke, hospitalization due to heart failure, or death due to CVD), death from another cause, or censoring. Cox proportional hazards model was used to estimate hazard ratios of MACE incidence and all\u2010cause mortality. Isotemporal time reallocations were used to demonstrate the dose\u2013response association between time spent in behaviors and outcome. The 24\u2010h time composition was significantly associated with incident MACE and all\u2010cause mortality. More time in MVPA relative to other behaviors was associated with a lower risk of events. Isotemporal time reallocations indicated that the greatest risk reduction occurred when MVPA replaced sleep. Higher MVPA associates with a reduced risk of incident MACE and all\u2010cause mortality after accounting for the 24\u2010h movement composition and confounders. Regular engagement in MVPA should be encouraged in midlife.<\/jats:p>","DOI":"10.1111\/sms.14315","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T19:29:01Z","timestamp":1673465341000},"page":"641-650","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Compositional association of 24\u2010h movement behavior with incident major adverse cardiac events and all\u2010cause mortality"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1008-3263","authenticated-orcid":false,"given":"Maisa","family":"Niemel\u00e4","sequence":"first","affiliation":[{"name":"Research Unit of Health Sciences and Technology University of Oulu  Oulu Finland"},{"name":"Medical Research Center University of Oulu and Oulu University Hospital  Oulu Finland"},{"name":"Department of Sports and Exercise Medicine Oulu Deaconess Institute Foundation sr.  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