{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T07:13:05Z","timestamp":1768288385724,"version":"3.49.0"},"reference-count":64,"publisher":"Korean Diabetes Association","issue":"1","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-dmj.org"],"crossmark-restriction":true},"short-container-title":["Diabetes Metab J"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:p>Background: Menopausal status can increase the risk of cardiocerebrovascular diseases (CCVDs) in women with type 2 diabetes mellitus (T2DM). Regular exercise is well-known to reduce this risk. This study explored the impact of exercise on CCVD and mortality in women with T2DM according to their menopausal status.Methods: A total of 32,477 premenopausal and 53,690 postmenopausal Korean women with T2DM aged 40 to 60 years from a national health examination cohort (2009 to 2018) were included. We evaluated risks for stroke, myocardial infarction (MI), and mortality based on exercise intensity. Cox proportional hazard regression analyses were performed to obtain the adjusted hazard ratio (aHR) and 95% confidence interval.Results: Exercise reduced stroke, MI, and mortality risks in women with T2DM, regardless of menopausal status. The highest effects of aHR compared to the sedentary group were 0.68 for stroke, 0.66 for MI, and 0.81 for mortality. Postmenopausal women experienced significant MI risk reductions at most exercise intensities, with the greatest reduction in the \u22651,500 metabolic equivalent of task score group unlike premenopausal women. However, stroke and mortality risk reductions in postmenopausal women were less pronounced compared to premenopausal women.Conclusion: Exercise reduces CCVD risk in women with T2DM across menopausal status. Postmenopausal women with T2DM had more benefits from exercise on MI but fewer benefits on stroke and mortality than premenopausal women. In premenopausal women with T2DM, exercise was not associated with a lower MI risk.<\/jats:p>","DOI":"10.4093\/dmj.2024.0487","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T05:11:47Z","timestamp":1755061907000},"page":"101-114","update-policy":"https:\/\/doi.org\/10.4093\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of Cardiocerebrovascular Risks and Exercise according to Menopausal Status in Women with Type 2 Diabetes Mellitus: A Nationwide Cohort Study"],"prefix":"10.4093","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6920-8750","authenticated-orcid":true,"given":"Ji-Hee","family":"Ko","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6286-7254","authenticated-orcid":true,"given":"Sun Joon","family":"Moon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyung-Do","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hye-Mi","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Se-Eun","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6108-7758","authenticated-orcid":true,"given":"Eun-Jung","family":"Rhee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1082-7592","authenticated-orcid":true,"given":"Won-Young","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2567","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-018-0728-6"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwt177"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-022-00708-0"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.2174\/1573403x16666201106141811"},{"key":"ref5","first-page":"S73","volume-title":"Physical activity\/exercise and diabetes mellitus","author":"Zinman","year":"2003"},{"key":"ref6","first-page":"766","volume-title":"Moderate exercise improves glucose metabolism in uncontrolled elderly patients with non-insulin-dependent diabetes mellitus","author":"Raz","year":"1994"},{"key":"ref7","first-page":"1228","volume-title":"Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis","author":"Chudyk","year":"2011"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-134-2-200101160-00009"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.7570\/jomes22007"},{"key":"ref10","first-page":"1345","volume-title":"American College of Sports Medicine position stand: exercise and type 2 diabetes","author":"Albright","year":"2000"},{"key":"ref11","first-page":"S68","volume-title":"5","author":"ElSayed","year":"2023"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1249\/01.mss.0000170083.41186.b1"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.12.017"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2023.06.023"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540400037028"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.4093\/dmj.2020.0254"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-1107"},{"key":"ref18","first-page":"1223","volume-title":"Composition of atherosclerotic plaques in coronary arteries in women less than 40 years of age with fatal coronary artery disease and implications for plaque reversibility","author":"Dollar","year":"1991"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1536\/ihj.16-095"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1097\/gme.0000000000002037"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.3803\/enm.2023.102"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.4093\/dmj.2023.0282"},{"key":"ref23","first-page":"S348","volume-title":"Korean version of international physical activity questionnaire (IPAQ) short form","author":"Kim","year":"2006"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.4082\/kjfm.2012.33.3.144"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5868-8-115"},{"key":"ref26","first-page":"1575","volume-title":"2011 Compendium of physical activities: a second update of codes and MET values","author":"Ainsworth","year":"2011"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-20351-w"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/653789"},{"key":"ref29","first-page":"S158","volume-title":"10","author":"ElSayed","year":"2023"},{"key":"ref30","first-page":"e147","volume-title":"Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement","author":"Colberg","year":"2010"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2022.792292"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2016.07.031"},{"key":"ref33","first-page":"471","volume-title":"Association between physical activity and risk of all-cause mortality and cardiovascular disease in patients with diabetes: a meta-analysis","author":"Kodama","year":"2013"},{"key":"ref34","first-page":"641","volume-title":"Cardiovascular implications of the menopause transition: endogenous sex hormones and vasomotor symptoms","author":"El Khoudary","year":"2018"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2018.00135"},{"key":"ref36","first-page":"e22992","volume-title":"Estrogen deficiency accelerates postmenopausal atherosclerosis by inducing endothelial cell ferroptosis through inhibiting NRF2\/GPX4 pathway","author":"Lv","year":"2023"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.2174\/1573403x15666190729153026"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1186\/s13293-017-0152-8"},{"key":"ref39","first-page":"e56","volume-title":"Heart disease and stroke statistics-2019 update: a report from the American Heart Association","author":"Benjamin","year":"2019"},{"key":"ref40","first-page":"1014","volume-title":"Ischemic heart disease in young women: JACC review topic of the week","author":"Minissian","year":"2022"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.2147\/ijwh.s107371"},{"key":"ref42","first-page":"645","volume-title":"Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes","author":"Saw","year":"2014"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12112457"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000564"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2014.06.011"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(22)00076-6"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-2244"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1113\/jp277764"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2183"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/204390"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1042\/cs20100174"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1113\/EP092191"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1113\/jp277056"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e6409"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.13.1465"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199109123251102"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.123.030105"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1056\/nejm198811173192004"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd011054.pub2"},{"key":"ref60","first-page":"e12241","volume-title":"Combined effect of physical exercise and hormone replacement therapy on cardiovascular and metabolic health in postmenopausal women: a systematic review and meta-analysis","author":"Sanchez-Delgado","year":"2023"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200029010-00004"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001189"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0000000000001063"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2021-105061"}],"container-title":["Diabetes &amp; Metabolism Journal"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-dmj.org\/upload\/pdf\/dmj-2024-0487.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-dmj.org\/journal\/view.php?doi=10.4093\/dmj.2024.0487","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-dmj.org\/upload\/pdf\/dmj-2024-0487.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T23:34:31Z","timestamp":1768260871000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-dmj.org\/journal\/view.php?doi=10.4093\/dmj.2024.0487"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,1]]},"references-count":64,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.4093\/dmj.2024.0487","relation":{},"ISSN":["2233-6079","2233-6087"],"issn-type":[{"value":"2233-6079","type":"print"},{"value":"2233-6087","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,1]]},"assertion":[{"value":"2024-12-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-13","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-01","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}