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Background: We aimed to evaluate the impact of low birth weight together with BMI during development for the risk of adult coronary heart disease (CHD). Methods: We included 35,659 men born 1945-1961 from the population-based BMI Epidemiology Study Gothenburg with data available on birth weight, BMI in childhood (8 years), BMI in young adulthood (20 years), and BMI change during puberty (BMI at 20 years - BMI at 8 years). Information on CHD diagnoses during follow-up was retrieved from high-quality national registers in Sweden. Hazard ratios (HR) for the risk of early and late CHD (before and after 58.4 years of age, respectively) were calculated using Cox regression models. Results: During follow-up, a total of 3380 cases of CHD (fatal and non-fatal) were diagnosed. Birth weight was inversely associated with the risk of both early and late CHD (early: HR 0.88 per SD increase, 95% Cl 0.84; 0.92; late: HR 0.94 per SD increase 95% Cl 0.90; 0.98) independently of BMI at 8 years and BMI change during puberty. In a model including birth weight together with overweight at 20 years, birth weight below the median (3.60 kg) and overweight at age 20 years was associated with an increased risk of both early and late CHD. Of note, a birth weight below the median, followed by overweight at 20 years of age was associated with a more than doubled risk of early CHD (HR 2.36, 95% Cl 1.92-2.91), compared to the reference group (birth weight above the median and normal weight at age at 20 years of age). Conclusions: We demonstrate that birth weight below the median followed by overweight in young adulthood double the risk for early CHD. These findings suggest that a life course perspective including birth weight and BMI during development should be used for CHD prevention and risk assessment in adults.