Adult weight change across the life course and cardiovascular disease prevalence and mortality

Background 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. Methods 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. Results 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. Conclusion 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

Body mass index · Disease · Hazard ratio · Logistic regression · Obesity · Odds ratio · Weight change · Weight gain · Young adult · Birth, Development, and Health · Diabetes, Cardiovascular Risks, and Lipoproteins · Obesity, Physical Activity, Diet

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