Adult weight change across the life course and cardiovascular disease prevalence and mortality: a population-based...

Associations between long-term adult weight change and cardiovascular disease (CVD) risk remain incompletely understood, especially regarding life-stage-specific patterns. We examined how weight-change trajectories across adulthood relate to CVD prevalence and mortality in a representative population.

We analyzed 35,998 adults aged ≥ 40 years in multiple townships or sub-districts, Xinyang City, Henan Province, China from 2010 to 2024. BMI at age 25, 10 years before baseline, and baseline was used to classify patterns: stable normal weight, maximum overweight, obese-to-non-obese, non-obese-to-obese, and stable obesity. Multivariable logistic regression estimated odds ratios (ORs) for CVD prevalence and subtypes; Cox models estimated hazard ratios (HRs) for CVD mortality, accounting for survey design.

At baseline, 6,112 participants had prevalent CVD. Over a median follow-up of 9.2 years (310,647 person-years), 2,314 participants died from CVD-related causes. From young to mid-adulthood, stable obesity was associated with higher odds of overall CVD (OR 1.92; 95% CI 1.38-2.65) and heart failure (OR 3.49; 95% CI 2.41-5.06). Transitioning from non-obesity to obesity also increased CVD risk. From mid to late adulthood, transitioning from obesity to non-obesity was associated with higher CVD prevalence (OR 2.00; 95% CI 1.61-2.48) and CVD mortality (HR 1.58; 95% CI 1.22-2.05). Large weight gain (≥ 20 kg) increased CVD risk, whereas later-life weight loss was associated with elevated CVD mortality.

Adult weight change relates to CVD risk in life-stage-specific and heterogeneous ways. Maintaining normal weight from early adulthood and preventing excessive long-term weight gain may reduce CVD risk. Considering the timing of body weight changes across the adult lifespan is of great public health significance for cardiovascular risk assessment.