Background: Excessive adiposity in adulthood is positively associated with the risk of cardiovascular disease (CVD). However, it is less studied how the risk is separately explained by early adulthood weight and later weight change, especially in Asian ancestries. Methods: This study included 121160 participants in a large population-based cohort in China. Body weight at 20 and 40 years of age wase self-reported. Information on CVD history was obtained through standard questionnaires. Results: The odds ratios (ORs) were 1.20 (95% CI, 1.10 & ndash;1.31) for coronary heart disease (CHD), 1.74 (95% CI, 1.36 & ndash;2.22) for myocardial infarction (MI), 1.14 (95% CI, 0.99 & ndash;1.32) for stroke and 1.21 (95% CI, 1.12 & ndash;1.31) for total CVD among individuals with early overweight, and became more prominent for early obesity. Meanwhile, A moderate weight gain of 2.5 kg between early adulthood and midlife significantly increased the risk of CHD (OR: 1.18, 95% CI: 1.05 & ndash;1.32), stroke (OR: 1.19, 95% CI: 1.03 & ndash;1.38) and total CVD (OR: 1.15, 95% CI: 1.04 & ndash;1.27), and the risk escalated with higher amounts of weight gain. Conversely, a weight loss of 2.5 kg conferred lower risk of CVD compared with a stable weight. In further cross-analysis, participants with early adulthood overweight or obesity and significant weight gain afterwards exhibited the greatest risk of CVD. Conclusions: High early adulthood BMI and subsequent weight gain had both independent and combined effect on the risk of CVD after midlife. Therefore, weight management should start before early adulthood, and empha-sized throughout adulthood for CVD prevention. (c) 2021 Elsevier B.V. All rights reserved.