Objective  To assess associations of sedentary behaviors with the incidence and risk factor clustering of cardiovascular disease (CVD) among adult residents in Jiangsu province and to provide evidences for the prevention and control of CVD.

  Methods  Using probability proportionate to size random sampling, we recruited 3 500 permanent residents 18 years old and elder at 7 chronic disease and risk factors surveillance sites in 7 municipalities of Jiangsu province; then baseline surveys, including questionnaire interview, physical examination and laboratory detection, were conducted during October – December 2010 and follow-up surveillances on CVD incidences were performed till the end of 2017 among the residents. Multivariate Cox proportional hazard model and unconditional logistic regression analysis and were adopted to assess the correlation between sedentary behavior and CVD incidence and clustering of CVD risk factors.

  Results  After excluding those with CVD or other severe diseases at the baseline survey, without valid information, or lost to follow-up, 3 019 residents were included the analysis, with a total of 17 926 person-years and an average period of 5.9 ± 0.9 years of follow-up. During the follow-up period among the participants, totally 143 CVD incidences were identified, with an incidence rate of 4.73%. The number (ratio) of participants reporting with one, two, and three or more CVD risk factors were 906 (30.0%), 901 (29.8%), and 728 (24.1%), respectively. Unconditional multivariate logistic regression analysis revealed that the participants with the sedentary time of 4 hours and more per day were more likely to report having three or more CVD risk factors (odds ratio OR = 1.41, 95% confidence interval CI: 1.05 − 1.89) compared to those with the sedentary time of 2 hours and less per day after adjusting for confounders including age, gender, education, marriage status, living region (urban or rural area), alcohol drinking, and physical activity. The participants with the sedentary time of 4 hours or more per day also had a significantly increased risk of CVD incidence (hazard ratio HR = 2.07, 95% CI: 1.07 − 3.40) in contrast to those with the sedentary time of 2 hours and less per day after adjusting for age, gender, living region, education, marital status, alcohol drinking, physical activity, smoking, and whether suffering from hypertension, diabetes, dyslipidemia, or central obesity in multivariate Cox proportional hazard regression analysis.

  Conclusion  Long time sedentary behavior is correlated with the clustering of CVD risk factors and increased risk of CVD incidence among adult residents in Jiangsu province.