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BACKGROUND To examine the association of baseline waist circumference(WC)and changes in WC with cardiovascular dis-ease(CVD)and all-cause mortality among elderly people.METHODS A total of 30,041 eligible participants were included from a retrospective cohort in China.The same questionnaire,anthropometric and laboratory measurements were performed at baseline(2010)and the first follow-up(2013).The percent change in WC between baseline and the first follow-up was calculated to evaluate three years change of WC.We collected the oc-currence of CVD and all-cause death from the first follow-up to December 31,2018.Restricted cubic splines and Cox proportional-hazards regression models were used to evaluate the relationship between baseline WC/changes in WC and mortality.RESULTS The dose-response relationships between baseline WC and CVD mortality were U-or J-shaped.In low WC group,compared with stable group,the fully adjusted hazard ratio(aHR)for CVD mortality was 1.60(95％CI:1.24-2.06)in WC gain group among men.In normal WC group,the CVD mortality risk increased with WC gain(men:aHR = 1.86,95％CI:1.36-2.56;women:aHR = 1.83,95％CI:1.29-2.58).In moderate-high WC group,the CVD mortality risk increased with WC gain(men:aHR =1.76,95％CI:1.08-2.88;women:aHR = 1.46,95％CI:1.04-2.05)and risk decreased with WC loss(men:aHR = 0.54,95％CI:0.30-0.98;women:aHR = 0.59,95％CI:0.37-0.96).CONCLUSIONS For the elderly population,WC gain may increase CVD mortality risk regardless of baseline WC,whereas WC reduction could decrease the risk only in the moderate-high WC group.