2187-P: Resistance Exercise Is Associated with Lower Risk of Cardiovascular Events and Mortality across the Cardiovascular–Kidney–Metabolic Syndrome Stages: A Nationwide Cohort Study

Introduction and Objective: The cardiovascular-kidney-metabolic (CKM) framework integrates metabolic, renal and cardiovascular (CV) risks to stratify the risk of CV events and mortality. However, whether resistance exercise reduces risk across the CKM continuum remains unclear. This study aimed to evaluate the association between resistance exercise frequency with CV events and mortality across the CKM syndrome stages in a nationwide cohort. Methods: Using data from the National Health Insurance Service, adults aged ≥40 years who underwent a health examination in 2019 were included. Participants were followed until December 31, 2023. Resistance exercise frequency was categorized as none, 1-2, or ≥3 times/week. Cox proportional hazards models were used to assess associations between resistance exercise and major CV events (CVD, myocardial infarction [MI], and stroke) and all-cause mortality. Results: Among 1,234,914 participants, higher resistance exercise frequency was consistently associated with reduced risks of CV events and all-cause mortality, regardless of CKM stage. For example, among participants with CKM stage 3, those performing resistance exercise ≥3 times/week had a significantly lower risk of CVD (hazard ratio [HR] 0.77; 95% CI 0.70-0.84), MI (HR 0.76; 95% CI 0.66-0.87), stroke (HR 0.78; 95% CI 0.70-0.89), and death (HR 0.65; 95% CI 0.60-0.80) compared with non-exercisers. Notably, individuals with CKM stage 3 who performed resistance exercise ≥3 times/week exhibited a CV event risk (HR 1.37) comparable to, or even lower than, non-exercisers in CKM stage 2 (HR 1.48). Subgroup analyses demonstrated consistent protective associations across age, sex, BMI, and diabetes status, with greater relative benefits observed in younger individuals. Conclusion: Resistance exercise is independently associated with reduced CV and mortality risk across all CKM syndrome stages, underscoring its role as a modifiable factor for risk reduction, even in advanced CKM stages.