We aimed to assess the non-genetic contribution to the associations between the change in weight and changes in cardiovascular disease (CVD) risk factors. This analysis included 194 Korean monozygotic (MZ) twin pairs (116 men, 272 women; mean age, 38.5 ± 6.8 years) who were first examined for weight and CVD risk factors (blood pressure (BP), glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL), and low-density lipoprotein cholesterol (LDL)) between December 2005 and December 2008, and returned for a repeat examination after 2.7 ± 0.9 years. The within-pair correlations were 0.21 for the change in weight and 0.05-0.42 for the changes in CVD risk factors. Bivariate analyses showed significant environmental correlations shared between the change in weight and the changes in CVD risk factors (p < .05), except for glucose, while there were no significant genetic effects shared between the phenotypes. After adjusting for baseline values of weight, smoking, and alcohol consumption, diastolic blood pressure (DBP), TG, TC, and LDL significantly increased by 1.6 mmHg, 0.09 mmol/L, 0.10 mmol/L, and 0.09 mmol/L, respectively, per 1 kg increase in within-pair differences in weight change. In Korean MZ twins, similarity between twins for changes in weight and CVD risk factors were small to moderate, and non-genetic factors were responsible for the associations between the change in weight and changes in DBP, TG, TC, and LDL.