Background <p>Australia has previously experienced adverse trends in overweight- and obesity-related cardiovascular disease (CVD) mortality. Its obesity prevalence is relatively high, increasing and shows wide socio-economic inequalities. However, socio-economic inequalities in premature overweight- and obesity-related CVD mortality rate and their trends are unknown. This study measures recent trends in premature overweight- and obesity-related CVD mortality in Australia from 2007 to 2022 and their area-level socio-economic inequalities.</p> Methods <p>Premature overweight- and obesity-related CVD mortality was measured as deaths at ages 35–74 years with a CVD reported with at least one (DKOLH-CVD) or two (DKOLH2-CVD) of diabetes, chronic kidney disease, obesity, lipidemias and hypertension. Age-standardised death rates (ASDR) from Australian death registration data were calculated. Inequalities were measured using the Index of Relative Socio-economic Advantage and Disadvantage (IRSAD) and analysed using rate ratios and the Relative Index of Inequality. Obesity prevalence data and their inequalities were also assessed using National Health Survey data.</p> Results <p>Premature overweight- and obesity-related CVD mortality, measured as the DKOLH-CVD ASDR, rose from 87.0 (95% confidence interval 84.6–89.5) per 100,000 in 2014 to 103.8 (101.1–106.5) in 2022 for males, or 19%, and from 44.6 (42.9–46.4) in 2013 to 50.5 (48.7–52.4) in 2022 for females, or 13%. When measured as DKOLH2-CVD ASDR, it increased by 37% for males and 21% for females from 2012 to 2022. DKOLH-CVD in ages 35–54 years rose by at least 45% from 2014 to 2022; average obesity prevalence since childhood or young adulthood of these age groups increased by approximately 50% from 2007 to 2022. The ratio of the male DKOLH-CVD ASDR of the most disadvantaged to the most advantaged IRSAD decile increased from 3.16 (2.93–3.41) in 2013–2015 to 3.51 (3.27–3.77) in 2020–2022 and for females from 4.55 (4.08–5.08) to 5.00 (4.51–5.54). Rate ratios were particularly high for DKOLH2-CVD and in ages 35–54 years. Similar socio-economic inequalities were found according to obesity prevalence.</p> Conclusions <p>The recent rise in premature overweight- and obesity-related CVD mortality in Australia, especially among those aged 35–54 years and in the most disadvantaged socio-economic deciles, closely mirrors Australia’s increasing obesity prevalence. Failure to effectively tackle Australia’s high obesity prevalence may have a significant detrimental long-term impact on mortality.</p>