心血管疾病（CVD）对公众健康构成重大威胁。有证据表明，中心性肥胖和正常体重指数 (BMI) 的结合与心血管疾病和死亡风险增加相关。然而，针对中国中老年人的证据有限。这是一项前瞻性队列研究，利用了 6,494 名 45 岁及以上成年人的全国代表性样本。这些人参加了2011年至2018年的中国健康与退休纵向研究。测量了身高、体重和腰围（WC），并根据身高和体重计算了BMI。其他变量是通过自我报告的问卷获得的。使用Cox比例风险回归模型进行关联分析。总共调查了10,186名参与者，并进行了57,185人年的随访。在此期间，发生了 1,571 例 CVD，其中包括 1,173 例心脏病和 527 例中风。调整年龄、性别、教育程度、婚姻状况、吸烟状况、饮酒量、社交活动、高血压、血脂异常、糖尿病、癌症、慢性肺病、肝病、肾病、消化系统疾病、ENP（情绪、神经等）等因素后， ，或精神问题）、记忆相关疾病、关节炎或风湿病、哮喘、自评健康和抑郁症，结果显示，与WC正常体重指数（BMI）正常的人相比，中心性肥胖者BMI正常的人的BMI为27.9 CVD 发病风险增加 %（95% 置信区间 [CI]：1.074-1.524），心脏病发病风险增加 33.4%（95% CI：1.095-1.625），但未发现与中风存在显着关联。此外，WC 正常且 BMI 较高的人，其 CVD 发病风险高出 24.6%（95% CI：1.046-1.483），心脏病发病风险高出 29.1%（95% CI：1.045-1.594）。与中风有显着相关性。最后，中心性肥胖高BMI个体的CVD发病风险高出49.3%（95% CI：1.273-1.751），心脏病发病风险高出61%（95% CI：1.342-1.931），心血管疾病发病风险高出34.2%。中风发生的风险较高（95% CI：1.008-1.786）。年龄和性别特异性分析进一步揭示了这些关联的不同趋势。我们发现，体重指数（BMI）和中心性肥胖与CVD发病率的联合关联表现出显着增强的预测价值。具体而言，高 BMI 合并中心性肥胖与 CVD 发病风险增加显着相关。此外，BMI正常或腰围正常且BMI较高的向心性肥胖会显着增加心脏病发病风险，但不会增加中风风险。值得注意的是，男性和中年人患心脏病的倾向更大。我们的研究强调了维持最佳体重指数和预防腹部肥胖对促进心血管健康的重要性。© 2024。作者。

Cardiovascular diseases (CVDs) pose a significant threat to public health. Evidence indicates that the combination of central obesity and normal body mass index (BMI) is associated with an increased risk of cardiovascular disease and mortality. However, limited evidences exists in middle aged and elderly adults in China.This was a prospective cohort study that utilized a nationally representative sample of 6,494 adults aged 45 years and above. These individuals participated in the China Health and Retirement Longitudinal Study spanning from 2011 to 2018. Height, weight and waist circumference (WC) were measured, and BMI was calculated by height and weight. Other variables were obtained through self-reported questionnaires. Association analysis was conducted using Cox proportional hazard regression models.A total of 10,186 participants were investigated, with 57,185 person-years of follow-up. During this period, 1,571 CVDs occurred, including 1,173 heart diseases and 527 strokes. After adjusting for various factors including age, gender, education, marital status, smoking status, alcohol intake, social activity, hypertension, dyslipidemia, diabetes, cancer, chronic lung diseases, liver disease, kidney disease, digestive disease, ENP(emotional, nervous, or psychiatric problems), memory related disease, arthritis or rheumatism, asthma, self-rated health and depression, the results revealed that compared to those with normal WC normal body mass index (BMI), individuals with central obesity normal BMI had a 27.9% higher risk of CVD incidence (95% confidence interval [CI]:1.074-1.524), and a 33.4% higher risk of heart disease incidence (95% CI:1.095-1.625), while no significant association was found with stroke. Additionally, those with normal WC high BMI showed a 24.6% higher risk of CVD incidence (95% CI:1.046-1.483), and a 29.1% higher risk of heart disease incidence (95% CI:1.045-1.594), again with no significant association with stroke. Finally, individuals with central obesity high BMI exhibited a 49.3% higher risk of CVD incidence (95% CI:1.273-1.751), a 61% higher risk of heart disease incidence (95% CI:1.342-1.931), and a 34.2% higher risk of stroke incidence (95% CI:1.008-1.786). Age- and sex- specific analyses further revealed varying trends in these associations.We discovered that the combined association of body mass index(BMI) and central obesity with CVD incidence exhibited a significantly enhanced predictive value. Specifically, a high BMI with central obesity was notably linked to an increased risk of CVD incidence. Additionally, central obesity with a normal BMI or a normal WC coupled with a high BMI significantly augmented the risk of heart disease incidence, but not stroke. Notably, male and middle-aged adults demonstrated a greater propensity for heart disease incidence. Our study underscores the importance of maintaining an optimal BMI and preventing abdominal obesity in promoting cardiovascular health.© 2024. The Author(s).