Background: Cross sectional measures of body mass index (BMI) are associated with cardiovascular disease (CVD) incidence, but less is known about whether weight change affects the risk of CVD. Methods: We estimated the effect of 2 year weight change interventions on 7 year risk of CVD, by emulating hypothetical target trials using electronic health records. We identified 138.567 individuals in England between 1998 and 2016, aged 45-69 years old, free of chronic diseases at baseline. We performed pooled logistic regression, using inverse-probability weighting to adjust for baseline and time-varying variables. Each individual was classified into a weight loss, maintenance, or gain group. Findings: In the normal weight, both weight loss and gain were associated with increased risk for CVD [HR vs weight maintenance=1.53 (1.18 to 1.98) and 1.43 (1.19 to 1.71 respectively)]. Among overweight individuals, both weight loss and gain groups, compared to weight maintenance, had a moderately higher risk of CVD [HR=1.20 (0.99 to 1.44) and 1.17 (0.99 to 1.38), respectively]. In the obese, weight loss had a lower risk lower risk of CHD [HR =0.66 (0.49 to 0.89)] and a moderately lower risk of CVD [HR =0.90 (0.72 to 1.13)]. When we assumed that a chronic disease occurred 1-3 years before the recorded date, estimates for weight loss and gain were attenuated among overweight individuals and estimates for weight loss were stronger among individuals with obesity. Interpretation: Among individuals with obesity, the weight loss group had a lower risk of CHD and moderately lower risk of CVD. Weight gain increased the risk of CVD across BMI groups.

中文翻译：

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体重正常，超重和肥胖且无慢性疾病的成年人的体重变化和心血管疾病的发生率；使用电子健康记录模拟试验

背景：体重指数（BMI）的横断面测量与心血管疾病（CVD）的发生率相关，但对于体重变化是否会影响CVD的风险知之甚少。方法：通过使用电子健康记录模拟假设的目标试验，我们评估了2年体重改变干预对7年CVD风险的影响。我们确定了1998年至2016年之间英格兰的138.567个人，年龄在45-69岁之间，基线时没有慢性病。我们使用反概率加权对基线和随时间变化的变量进行调整，从而进行汇总逻辑回归。将每个人分为减肥，维持或增加体重组。结果：在正常体重中，体重减轻和增重均与CVD风险增加相关[HR与体重维持率分别为1.53（1.18至1.98）和1.43（1。19至1.71））。在超重人群中，体重减轻和增重组与维持体重相比，有较高的CVD风险[HR分别为1.20（0.99至1.44）和1.17（0.99至1.38）]。在肥胖者中，体重减轻具有较低的冠心病风险[HR = 0.66（0.49至0.89）]，具有较低的CVD风险[HR = 0.90（0.72至1.13）]。当我们假设慢性病在记录的日期之前1-3年发生时，超重个体的体重减轻和增重估计减弱，而肥胖个体的体重减轻估计更强。解释：在肥胖个体中，减肥组患冠心病的风险较低，而患CVD的风险较低。体重增加增加了BMI组患CVD的风险。与维持体重相比，减肥组和增重组都有较高的CVD风险[HR分别为1.20（0.99至1.44）和1.17（0.99至1.38）]。在肥胖者中，体重减轻具有较低的冠心病风险[HR = 0.66（0.49至0.89）]，具有较低的CVD风险[HR = 0.90（0.72至1.13）]。当我们假设慢性病在记录的日期之前1-3年发生时，超重个体的体重减轻和增重估计减弱，而肥胖个体的体重减轻估计更强。解释：在肥胖个体中，减肥组患冠心病的风险较低，而患CVD的风险较低。体重增加增加了BMI组患CVD的风险。与维持体重相比，减肥组和增重组均具有较高的CVD风险[HR分别为1.20（0.99至1.44）和1.17（0.99至1.38）]。在肥胖者中，体重减轻具有较低的冠心病风险[HR = 0.66（0.49至0.89）]，具有较低的CVD风险[HR = 0.90（0.72至1.13）]。当我们假设慢性病在记录的日期之前1-3年发生时，超重个体的体重减轻和增加的估计减弱，而肥胖个体的体重减轻的估计更强。解释：在肥胖个体中，减肥组患冠心病的风险较低，而患CVD的风险较低。体重增加增加了BMI组患CVD的风险。17（分别为0.99至1.38）]。在肥胖者中，体重减轻具有较低的冠心病风险[HR = 0.66（0.49至0.89）]，具有较低的CVD风险[HR = 0.90（0.72至1.13）]。当我们假设慢性病在记录的日期之前1-3年发生时，超重个体的体重减轻和增重估计减弱，而肥胖个体的体重减轻估计更强。解释：在肥胖个体中，减肥组患冠心病的风险较低，而患CVD的风险较低。体重增加增加了BMI组患CVD的风险。17（分别为0.99至1.38）]。在肥胖者中，体重减轻具有较低的冠心病风险[HR = 0.66（0.49至0.89）]，具有较低的CVD风险[HR = 0.90（0.72至1.13）]。当我们假设慢性病在记录的日期之前1-3年发生时，超重个体的体重减轻和增重估计减弱，而肥胖个体的体重减轻估计更强。解释：在肥胖个体中，减肥组患冠心病的风险较低，而患CVD的风险较低。体重增加增加了BMI组患CVD的风险。当我们假设慢性病在记录的日期之前1-3年发生时，超重个体的体重减轻和增重估计减弱，而肥胖个体的体重减轻估计更强。解释：在肥胖个体中，减肥组患冠心病的风险较低，而患CVD的风险较低。体重增加增加了BMI组患CVD的风险。当我们假设慢性病在记录的日期之前1-3年发生时，超重个体的体重减轻和增重估计减弱，而肥胖个体的体重减轻估计更强。解释：在肥胖个体中，减肥组患冠心病的风险较低，而患CVD的风险较低。体重增加增加了BMI组患CVD的风险。