Is it true that people with obesity have poorer cardiovascular health than those with a normal weight, especially as they age?
Not always. According to research published Wednesday in the Lancet, individuals over 40 with obesity can maintain blood pressure and cholesterol levels comparable to their peers with a normal body mass index (BMI). This study observed these cardiovascular risk factors in adults of various ages and BMIs over 25 years, during a period before the advent of new obesity drugs but marked by increased use of more affordable statins and blood pressure medications.
Since 1990, declines in blood pressure and unhealthy cholesterol levels have been more pronounced among those considered overweight (BMI over 25) or obese (BMI 30 and above) aged 40 to 79, compared to their counterparts with a BMI of 20 to 25, as reported by researchers from the NCD Risk Factor Collaboration. By 2024, participants in their 60s and 70s displayed blood pressure and cholesterol levels on par with or lower than those of older adults with normal BMI.
For individuals under 40, such alignment between different BMI groups was not observed, likely due to less frequent screenings for these silent health threats.
In an accompanying commentary, Yuan Lu from Yale University viewed the aligning risk factor levels as a positive development for preventive cardiology.
“The findings should not be interpreted as evidence that obesity has become benign,” she noted. “Rather, the findings suggest that some cardiovascular consequences of obesity are increasingly being attenuated through medical management.”
Throughout the study, blood pressure medications and statins for lowering cholesterol became more prevalent among middle-aged individuals with obesity compared to those without, likely contributing to the improved figures. These medications have been available in generic form for a long time, costing approximately $100 annually in the U.S.
In the oldest age group, 70% to 72% of adults with overweight or obesity were using blood pressure medications or statins, compared to 40% to 48% of those with normal BMI. In contrast, young adults under 40, regardless of BMI, seldom received these medications.
“This is good news. It’s important information, but it’s important to realize what the study does and does not say,” commented Dan Jones, who chaired the American Heart Association’s 2025 blood pressure guideline committee, though he did not participate in the study. “What you really want to know is whether this improves cardiovascular outcomes or kidney outcomes for these patients.”
The study, being observational, does not establish cause and effect. To draw its conclusions, researchers analyzed blood pressure and cholesterol data from individuals with obesity, overweight, and normal BMI across 110 health datasets, involving 1 million participants from 1990 to 2024 in seven countries: England, the United States, Japan, South Korea, Taiwan, Thailand, and Finland. The changes were less marked in Taiwan and Thailand.
Majid Ezzati, a co-author and professor of global environmental health at Imperial College London, stated in a media briefing that the nature of obesity has evolved since the late 20th century.
“This may well be partly because of higher use of antihypertensive and lipid-lowering medicines,” he explained. “Young adults haven’t seen these metabolic benefits, and they remain at metabolic high risk.”
Timothy Anderson, a primary care physician and assistant professor at the University of Pittsburgh Medical Center, noted missed opportunities for prevention among younger adults. Though not involved in the Lancet study, he contributed to the 2026 statin guideline recommendations.
“Ideally, when people are young and low risk, the focus is really on how do we help people lose weight through diet and exercise and other lifestyle modifications if they’re just barely high with their blood pressure or cholesterol, to actually get them into a normal range or avoid the need to be on treatment in the future,” he stated.
Factors like diets with less salt and fat, increased fruit and vegetable consumption, more physical activity, and reduced smoking might also influence these outcomes.
Edward Gregg, another co-author and professor at Imperial College London, emphasized that obesity doesn’t exist in isolation. “You can be obese and have healthy levels of risk factors, but that doesn’t mean that obesity does not still increase your risk of other outcomes,” he said, including diabetes, cancer, kidney disease, and musculoskeletal conditions.
Jones added, “There are things related to cardiovascular disease that will be different between obese and non-obese patients, other than non-HDL cholesterol and blood pressure. Diabetes, for example, or levels of inflammation. Those are both things that directly affect cardiovascular risk.”
It’s possible to appear healthy yet still be at high risk. Anderson pointed out, “There are plenty of very thin folks who have very high cholesterol or very high blood pressure due to other causes,” listing kidney disease or genetic predisposition as examples.
When asked about young people with obesity who aren’t prescribed medications for blood pressure or cholesterol, the authors expressed concern about the longer duration of obesity in younger generations. Paul Franks, a professor at Lund University, remarked, “It’s quite worrying to see the younger adults in this study not benefiting to the same extent. It will be concerning to see what happens over the next decades to those individuals.”
Franks also noted that reversing damage from high blood pressure and cholesterol is challenging. He explained that atherosclerosis, resulting from hypertension and elevated cholesterol, is irreversible. “Once you get those plaques on the arteries, they will stay there. You can reduce the volume of the fat inside the plaques, but you can’t get rid of the plaques themselves,” he said. “If you start to acquire those at a young age, that is a real problem.”
Jones highlighted that access to healthcare and nutritious food is critical for young people. “It’s a real problem in prevention of cardiovascular disease and kidney disease in particular. We have so many people who don’t get evaluated until they’re in their 40s,” he said. “We’ve got to start earlier and more aggressively identifying risk factors in young adults.”
Anderson observed that younger patients have historically preferred lifestyle changes over medications. However, he noted a shift in the GLP-1 era, where these patients are more open to medications that might impact appearance and body image.
While the study didn’t encompass the era of obesity drugs, Anderson emphasized the growing role of these medications in managing metabolic issues. Franks cautioned against viewing GLP-1s as a total solution, suggesting they are part of a more complex approach.
Jones compared the current enthusiasm for new drugs to past excitement over ACE inhibitors, which treat blood pressure, heart failure, and kidney issues. “We have people now speculating that SGLT2 inhibitors and GLP-1 agonists are going to make it unnecessary to focus so much on getting LDL cholesterol control and blood pressure control. But that’s speculation. We don’t know yet,” he stated. “For the time being, we have to assume that getting those things under control, if you’re taking the new obesity drugs or not, is still important until somebody proves otherwise.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
