| Summary: | Abstract Background The risk of cardiovascular diseases has rapidly increased among middle-aged and elderly. However, little is known about the relationship of body composition changes with the risk of cardiovascular events among this population in China. We explored the associations of 2-year changes in fat percentage (fat%) and fat-free mass percentage (FFM%) with subsequent cardiovascular events in a middle-aged and elderly community-based cohort. Methods This study included 1048 participants (456 men [43.51%], aged 50–80 years) without overt cardiovascular disease, who underwent two examinations during 2013–2014 and 2015–2016. All participants were followed up until 2022 for cardiovascular events. A bioelectrical impedance analyzer was used to calculate fat% and FFM% change. Results At baseline, the median body mass index (BMI), fat%, and FFM% were 23.9 (22.1–25.9) kg/m2, 27.2 (20.8–33.6)%, and 72.8 (66.4–79.2)%, respectively. Two-year changes in fat% and FFM% were 0.31 (− 5.53 to 6.87)% and − 0.12 (− 2.36 to 2.06)%. During an average follow-up of 5.5 years, 86 cardiovascular events (8.21%) occurred. Cox regression models showed that hazard ratios (HRs) of every 2% change in fat% and FFM% for cardiovascular events were 1.04 (95% confidence interval [CI] 1.01–1.07) and 0.84 (95% CI 0.74–0.95), respectively. Compared with participants with stable fat% (–2% ≤ ⊿fat% < 2%), those with fat% gain ≥ 2% had an increased risk of cardiovascular events (HR 2.07, 95% CI 1.08–3.97). FFM% loss > 8% was associated with a higher risk of cardiovascular events (HR 3.83, 95% CI 1.29–11.4). Conclusions In a middle-aged and elderly community-based Chinese population, fat% gain or FFM% loss was associated with an increased risk of cardiovascular events.
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