People with obesity have worse cardiovascular health than people with normal weight, especially as they get older, right?
Not necessarily. People over 40 with obesity appear to have both their blood pressure and cholesterol under control at levels rivaling their peers with normal body mass index, research published Wednesday in the Lancet has found. The new study tracked these cardiovascular risk factors in adults of varying ages and BMIs for 25 years, an era preceding new obesity drugs but coinciding with expanded use of far less costly statins and blood pressure pills.
Since 1990, blood pressure and unhealthy cholesterol levels fell more sharply among people considered overweight (BMI over 25) or with obesity (BMI 30 and above) who are 40 to 79 years old than among people the same age who have a body mass index of 20 to 25, researchers from the NCD Risk Factor Collaboration reported. By 2024, the 60- and 70-year-olds in the study had blood pressure and unhealthy cholesterol levels similar to or even lower than older adults with normal BMI.
For adults under 40, there was no such convergence between differing BMI groups, likely reflecting less screening for the two silent dangers.
In a commentary published with the study, Yuan Lu of Yale University saw the converging risk factor levels as a win for preventive cardiology.
“The findings should not be interpreted as evidence that obesity has become benign,” she wrote. “Rather, the findings suggest that some cardiovascular consequences of obesity are increasingly being attenuated through medical management.”
Over the study period, blood pressure drugs and statins to lower harmful cholesterol became more widely used by middle-age people with obesity compared to those without obesity, making the medications a likely driver of the improving numbers. Blood pressure medications and statins have long been available in generic form, costing around $100 a year in the U.S.
In the oldest age cohort, 70% to 72% of adults with overweight or obesity were taking blood pressure drugs or statins compared to 40% to 48% of people that age with normal BMI. Young adults under 40 rarely received cholesterol or blood pressure medication, the analysis found, regardless of their BMI.
“This is good news. It’s important information, but it’s important to realize what the study does and does not say,” Dan Jones, a former president of the American Heart Association who chaired the organization’s 2025 blood pressure guideline committee, told STAT. He was not involved in the new study. “What you really want to know is whether this improves cardiovascular outcomes or kidney outcomes for these patients.”
The study was observational, meaning it can’t establish cause and effect. To reach its conclusion about diminishing differences, the authors analyzed blood pressure and cholesterol readings in people with obesity, overweight, and normal BMI from 110 health datasets. There were 1 million participants from 1990 to 2024 in seven countries: England, the United States, Japan, South Korea, Taiwan, Thailand, and Finland. Changes in blood pressure and cholesterol were less pronounced in Taiwan and Thailand.
Since the end of the 20th century, the character of obesity has changed, study co-author Majid Ezzati, a professor of global environmental health at Imperial College London, said in a media briefing Tuesday.
“This may well be partly because of higher use of antihypertensive and lipid-lowering medicines,” he said. “Young adults haven’t seen these metabolic benefits, and they remain at metabolic high risk.”
There are many missed opportunities for prevention in younger adults, Timothy Anderson, a primary care physician and assistant professor of medicine at the University of Pittsburgh Medical Center, told STAT. He was not involved in the Lancet study, but he was a member of the writing committee that issued 2026 recommendations on when to consider statins or other measures to manage cholesterol.
“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 said.
Other factors that could play roles include diets lower in salt and fats while higher in fruits and vegetables. More physical activity might also play a role. Less smoking is likely to have helped, too.
“This paper’s a reminder that obesity doesn’t occur in a vacuum,” co-author Edward Gregg, a professor of epidemiology and biostatistics at Imperial College London, said at the briefing. “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,” such as diabetes, cancer, kidney disease, and musculoskeletal conditions.
“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,” Jones said. “Diabetes, for example, or levels of inflammation. Those are both things that directly affect cardiovascular risk.”
You can also appear to be healthy yet be at high risk.
“There are plenty of very thin folks who have very high cholesterol or very high blood pressure due to other causes,” Anderson said, citing kidney disease or genetic predisposition.
Asked about young people with obesity who aren’t prescribed drugs to lower blood pressure or unhealthy cholesterol, the authors expressed concern about living more years with obesity than previous generations.
“It’s quite worrying to see the younger adults in this study not benefiting to the same extent,” Paul Franks, a professor of genetic epidemiology at Lund University, said at the briefing. “It will be concerning to see what happens over the next decades to those individuals.”
It may look like the clock can be turned back on high blood pressure and cholesterol numbers, but some of their damage cannot be undone, Franks said. Atherosclerosis, following hypertension and elevated cholesterol, is not reversible.
“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.”
For young people, it comes down to access, former AHA chief Jones said, whether it’s finding health care or healthy food.
“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.”
Historically, younger patients have preferred trying a better diet and more exercise as opposed to starting statins or blood pressure pills, Anderson said, but that may no longer be the case.
“I think that’s really changed in the GLP-1 era, where younger patients are interested in those medications to a much greater extent than they are for other medications that are treating your health but that may not have an outward impact on appearance and body image,” he said.
Medical management of metabolic problems increasingly means obesity drugs, something the study didn’t consider given its time frame.
“I think we want to be very careful about saying that GLP-1s are the panacea for the entire problem of obesity and cardiometabolic disease,” co-author Franks said. “They clearly aren’t. They’re part of the solution, but the solution will be complex and different for different people.”
Jones was also circumspect, recalling that ACE inhibitors, drugs to treat blood pressure, heart failure, and kidney problems, were once hailed in a similar fashion.
“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 said. “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.”
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